Provider Demographics
NPI:1225717150
Name:PRETTYBULL, JENNIFER (SWLC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PRETTYBULL
Suffix:
Gender:F
Credentials:SWLC
Other - Prefix:
Other - First Name:JP
Other - Middle Name:
Other - Last Name:PRETTYBULL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SWLC
Mailing Address - Street 1:PO BOX 1183
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-1183
Mailing Address - Country:US
Mailing Address - Phone:646-860-8904
Mailing Address - Fax:
Practice Address - Street 1:63 BOGEY DR
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-9656
Practice Address - Country:US
Practice Address - Phone:646-860-8904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-62383104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker