Provider Demographics
NPI:1447207865
Name:STIFFLER, LORETTA J (MSW)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:J
Last Name:STIFFLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 STEELE ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2135
Mailing Address - Country:US
Mailing Address - Phone:406-490-0493
Mailing Address - Fax:
Practice Address - Street 1:1129 STEELE ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2135
Practice Address - Country:US
Practice Address - Phone:406-490-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT503178Medicaid
MT503178Medicaid