Provider Demographics
NPI:1164113130
Name:DUCKLOW, JEFF ALLAN
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:ALLAN
Last Name:DUCKLOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 KENSINGTON AVE STE 3A715
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5769
Mailing Address - Country:US
Mailing Address - Phone:406-552-3760
Mailing Address - Fax:
Practice Address - Street 1:715 KENSINGTON AVE STE 3A715
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5769
Practice Address - Country:US
Practice Address - Phone:406-552-3760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT139225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist