Provider Demographics
NPI:1245632512
Name:DIBBLE, MARIE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:DIBBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 LT MOSS RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7220
Mailing Address - Country:US
Mailing Address - Phone:406-532-8426
Mailing Address - Fax:406-543-9316
Practice Address - Street 1:600 DEWEY BLVD
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-3214
Practice Address - Country:US
Practice Address - Phone:406-723-1692
Practice Address - Fax:406-723-1690
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCSW-LIC-77121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical