Provider Demographics
NPI:1174833453
Name:FINNEGAN, ANN ELIZABETH
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:ELIZABETH
Last Name:FINNEGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 AVON LN
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-9514
Mailing Address - Country:US
Mailing Address - Phone:509-954-6198
Mailing Address - Fax:
Practice Address - Street 1:6110 AVON LN
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-9514
Practice Address - Country:US
Practice Address - Phone:509-954-6198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-387271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-LCSW-LIC-38727OtherSOCIAL WORK