Provider Demographics
NPI:1871690834
Name:MCADAM, JACQUELINE J
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:J
Last Name:MCADAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:J
Other - Last Name:BOZUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1826 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-5406
Mailing Address - Country:US
Mailing Address - Phone:406-299-2450
Mailing Address - Fax:406-299-3117
Practice Address - Street 1:1826 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-5406
Practice Address - Country:US
Practice Address - Phone:406-299-2450
Practice Address - Fax:406-299-3117
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1675PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1871690834Medicaid
MT3402438Medicaid