Provider Demographics
NPI:1376783142
Name:WIDMER, THADDEUS J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THADDEUS
Middle Name:J
Last Name:WIDMER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2739
Mailing Address - Country:US
Mailing Address - Phone:406-531-8846
Mailing Address - Fax:
Practice Address - Street 1:150 MORNING STAR WAY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3604
Practice Address - Country:US
Practice Address - Phone:406-531-8846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical