Provider Demographics
NPI:1699838193
Name:FODNESS, KARIN (LCSW)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:FODNESS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 N 1ST ST W
Mailing Address - Street 2:STE C
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3661
Mailing Address - Country:US
Mailing Address - Phone:406-396-2762
Mailing Address - Fax:406-728-5178
Practice Address - Street 1:235 N 1ST ST W
Practice Address - Street 2:STE C
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3661
Practice Address - Country:US
Practice Address - Phone:406-721-7690
Practice Address - Fax:406-541-6567
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT726-LCSW1041C0700X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical