Provider Demographics
NPI:1376843706
Name:SPOTTED EAGLE, LATONNA MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LATONNA
Middle Name:MARIE
Last Name:SPOTTED EAGLE
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 1:760 HOSPITAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BROWNING
Mailing Address - State:MT
Mailing Address - Zip Code:59417
Mailing Address - Country:US
Mailing Address - Phone:406-338-6149
Mailing Address - Fax:406-338-6294
Practice Address - Street 1:760 HOSPITAL CIRCLE
Practice Address - Street 2:
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417
Practice Address - Country:US
Practice Address - Phone:406-338-6149
Practice Address - Fax:406-338-6294
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker