Provider Demographics
NPI:1851437305
Name:MOON, JOANN POLK (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:POLK
Last Name:MOON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JOANN
Other - Middle Name:LUCILLE
Other - Last Name:POLK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:74 WALKING HORSE WAY
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-9743
Mailing Address - Country:US
Mailing Address - Phone:406-599-0206
Mailing Address - Fax:406-582-7483
Practice Address - Street 1:1707 S CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5811
Practice Address - Country:US
Practice Address - Phone:406-586-4308
Practice Address - Fax:406-522-0373
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical