Provider Demographics
NPI:1013110113
Name:WOLLERSHEIM, JANET P (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:P
Last Name:WOLLERSHEIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625B TANBARK WAY
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5418
Mailing Address - Country:US
Mailing Address - Phone:406-274-4714
Mailing Address - Fax:
Practice Address - Street 1:1900 BROOKS ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6644
Practice Address - Country:US
Practice Address - Phone:406-274-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical