Provider Demographics
NPI:1336559061
Name:PANCHERI JOHNSON, MANDEE (LCSW)
Entity Type:Individual
Prefix:
First Name:MANDEE
Middle Name:
Last Name:PANCHERI JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 VISTA LOOP
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2542
Mailing Address - Country:US
Mailing Address - Phone:406-871-0707
Mailing Address - Fax:
Practice Address - Street 1:412 1ST AVE W
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4836
Practice Address - Country:US
Practice Address - Phone:406-257-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT24781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical