Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 1038 | MT |
NPI | 1003155417 |
---|---|
Provider Name | Grace Linda Subatch |
First Address | Whitefish, MT 59937-7838 |
Second Address | Whitefish, MT 59937-7838 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2013 |
Last Update Date | 05/02/2013 |