Provider Demographics
NPI:1275695330
Name:ANDERSON, STEWART CHARLES (MSW)
Entity Type:Individual
Prefix:MR
First Name:STEWART
Middle Name:CHARLES
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:EMIGRANT
Mailing Address - State:MT
Mailing Address - Zip Code:59027-1125
Mailing Address - Country:US
Mailing Address - Phone:406-333-4738
Mailing Address - Fax:406-333-4738
Practice Address - Street 1:13 VICTORIA LANE
Practice Address - Street 2:
Practice Address - City:EMIGRANT
Practice Address - State:MT
Practice Address - Zip Code:59027-1125
Practice Address - Country:US
Practice Address - Phone:406-333-4738
Practice Address - Fax:406-333-4738
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical