Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003230152 |
---|---|
Provider Name | Mr. Patrick Harlan Maddison |
First Address | Missoula, MT 59801-3028 |
Second Address | Missoula, MT 59801-3028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2014 |
Last Update Date | 10/02/2014 |