Provider Demographics
NPI:1376609941
Name:SUDA, WILLIAM LEROY (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LEROY
Last Name:SUDA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1201 WESTWOOD DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2305
Mailing Address - Country:US
Mailing Address - Phone:406-363-2266
Mailing Address - Fax:406-363-2266
Practice Address - Street 1:1201 WESTWOOD DR
Practice Address - Street 2:SUITE C
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2305
Practice Address - Country:US
Practice Address - Phone:406-363-2266
Practice Address - Fax:406-363-2266
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT89103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT49-1244Medicaid
MT163709OtherMENTAL HEALTH NETWORK
MT51550OtherBLUE CROSS BLUE SHIELD