Provider Demographics
NPI:1134333610
Name:PIERSALL, ROBERT J (MSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:PIERSALL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 6TH AVE E
Mailing Address - Street 2:SUITE 12
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5005
Mailing Address - Country:US
Mailing Address - Phone:406-755-3134
Mailing Address - Fax:
Practice Address - Street 1:725 6TH AVE E
Practice Address - Street 2:SUITE 12
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5005
Practice Address - Country:US
Practice Address - Phone:406-755-3134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000501878Medicaid
MT07006-1OtherBCBS OF MONTANA