Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 347 | MT |
Y | 103T00000X | Psychologist | 347 | MT |
NPI | 1003832932 |
---|---|
Provider Name | Susan K. Day |
First Address | Missoula, MT 59802-4011 |
Second Address | Missoula, MT 59802-4011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 26/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0492065 | (05) | MT |
P00126297 | RAILROAD MEDICARE (01) | MT |
P00139 | (02) |