Provider Demographics
NPI:1518543545
Name:WOODMAN, CALLIE MONROE (MA)
Entity Type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:MONROE
Last Name:WOODMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 S 9TH ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3434
Mailing Address - Country:US
Mailing Address - Phone:406-546-4043
Mailing Address - Fax:
Practice Address - Street 1:1621 S 9TH ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3434
Practice Address - Country:US
Practice Address - Phone:406-546-4043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-39115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty