Provider Demographics
NPI:1326174566
Name:DAY, JACQUELINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:DAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SW HIGGINS AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1341
Mailing Address - Country:US
Mailing Address - Phone:406-542-2628
Mailing Address - Fax:
Practice Address - Street 1:1001 SW HIGGINS AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1341
Practice Address - Country:US
Practice Address - Phone:406-542-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT241103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0492184Medicaid