Provider Demographics
NPI:1801155361
Name:MCCORMICK, JOANNA LEGERSKI (PHD)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:LEGERSKI
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:LEGERSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:723 5TH AVE E
Mailing Address - Street 2:SUITE 130
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5321
Mailing Address - Country:US
Mailing Address - Phone:406-546-4323
Mailing Address - Fax:406-257-9721
Practice Address - Street 1:723 5TH AVE E
Practice Address - Street 2:SUITE 130
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5321
Practice Address - Country:US
Practice Address - Phone:406-546-4323
Practice Address - Fax:406-257-9721
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2014-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT933103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical