Provider Demographics
NPI:1831495530
Name:BALFOURD, DEETTE (CPCP)
Entity Type:Individual
Prefix:MRS
First Name:DEETTE
Middle Name:
Last Name:BALFOURD
Suffix:
Gender:F
Credentials:CPCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 STAGECOACH TRL
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-6981
Mailing Address - Country:US
Mailing Address - Phone:406-370-3705
Mailing Address - Fax:
Practice Address - Street 1:1821 SOUTH AVE W
Practice Address - Street 2:404
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6517
Practice Address - Country:US
Practice Address - Phone:406-370-3705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10049247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other