Provider Demographics
NPI:1013932813
Name:WALL-HOEBEN, COLLEEN M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:M
Last Name:WALL-HOEBEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 WEST MAIN
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840
Mailing Address - Country:US
Mailing Address - Phone:406-375-2570
Mailing Address - Fax:406-375-2570
Practice Address - Street 1:127 W MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2581
Practice Address - Country:US
Practice Address - Phone:406-375-2570
Practice Address - Fax:406-375-2570
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT348103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0491691Medicaid
MT0491691Medicaid