Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003190778 |
---|---|
Provider Name | Jennifer Walrod |
First Address | Missoula, MT 59803-1630 |
Second Address | Missoula, MT 59803-1630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2011 |
Last Update Date | 11/01/2017 |