Provider Demographics
NPI:1629754619
Name:DORSETT, DERIN AIMEE (SWLC)
Entity Type:Individual
Prefix:
First Name:DERIN
Middle Name:AIMEE
Last Name:DORSETT
Suffix:
Gender:F
Credentials:SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 US HIGHWAY 2 E
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2815
Mailing Address - Country:US
Mailing Address - Phone:406-890-0746
Mailing Address - Fax:
Practice Address - Street 1:2209 US HIGHWAY 2 E
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2815
Practice Address - Country:US
Practice Address - Phone:406-890-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-63407104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker