Provider Demographics
NPI:1407010317
Name:JEANETTE STANGL INC PC
Entity Type:Organization
Organization Name:JEANETTE STANGL INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STANGL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LAC
Authorized Official - Phone:406-542-8461
Mailing Address - Street 1:415 E KENT AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:821 SOUTH ORANGE ST
Practice Address - Street 2:SACAJAWEA OFFICES
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6724
Practice Address - Country:US
Practice Address - Phone:406-542-8461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT454251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health