Provider Demographics
NPI:1477753366
Name:DIANE V HADDON PLLC
Entity Type:Organization
Organization Name:DIANE V HADDON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:V
Authorized Official - Last Name:HADDON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:406-721-6144
Mailing Address - Street 1:210 N HIGGINS AVE
Mailing Address - Street 2:SUITE 324
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4462
Mailing Address - Country:US
Mailing Address - Phone:406-721-6144
Mailing Address - Fax:406-721-6709
Practice Address - Street 1:210 N HIGGINS AVE
Practice Address - Street 2:SUITE 324
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4462
Practice Address - Country:US
Practice Address - Phone:406-721-6144
Practice Address - Fax:406-721-6709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT289LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000502203Medicaid