Provider Demographics
NPI:1184452138
Name:SCALLY HEALTH AND WELLNESS PLLC
Entity type:Organization
Organization Name:SCALLY HEALTH AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCALLY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:406-361-5093
Mailing Address - Street 1:2431 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-1239
Mailing Address - Country:US
Mailing Address - Phone:406-361-5093
Mailing Address - Fax:406-720-7944
Practice Address - Street 1:2431 RIVER RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-1239
Practice Address - Country:US
Practice Address - Phone:406-361-5093
Practice Address - Fax:406-720-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty