Provider Demographics
NPI:1841908878
Name:LEGG, JANNA (LCSC, MSW)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:
Last Name:LEGG
Suffix:
Gender:F
Credentials:LCSC, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13053 KIMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-9520
Mailing Address - Country:US
Mailing Address - Phone:406-545-0420
Mailing Address - Fax:
Practice Address - Street 1:445 S 5TH ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2619
Practice Address - Country:US
Practice Address - Phone:406-545-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-515151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE