Provider Demographics
NPI:1255143087
Name:BOSTROM, ALEX (SWLC)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:BOSTROM
Suffix:
Gender:F
Credentials:SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 AVENUE D STE C
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3043
Mailing Address - Country:US
Mailing Address - Phone:406-272-2511
Mailing Address - Fax:406-204-0474
Practice Address - Street 1:21 N LAST CHANCE GULCH STE 201
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4108
Practice Address - Country:US
Practice Address - Phone:406-272-2511
Practice Address - Fax:406-204-0474
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-784811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical