Basic Information
| Provider Information | |||||||||
| NPI: | 1174977599 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSE | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 KASOTA CT | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598031257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066725004 | ||||||||
| FaxNumber: | 4068303156 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 S RESERVE ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598013103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063273057 | ||||||||
| FaxNumber: | 4063273231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2016 | ||||||||
| LastUpdateDate: | 06/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | BBH-LCSW-LIC-16879 | MT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.