Provider Demographics
NPI:1932724960
Name:KJELLAND, TAHJ B
Entity Type:Individual
Prefix:
First Name:TAHJ
Middle Name:B
Last Name:KJELLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2751
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-2751
Mailing Address - Country:US
Mailing Address - Phone:406-818-1111
Mailing Address - Fax:
Practice Address - Street 1:1580 MILWAUKEE WAY
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3006
Practice Address - Country:US
Practice Address - Phone:406-818-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT331281041C0700X
251E00000X
331281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251E00000XAgenciesHome Health