Provider Demographics
NPI:1982389268
Name:HERZOG, MEREDITH E (SWLC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:E
Last Name:HERZOG
Suffix:
Gender:F
Credentials:SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 MOON CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-1508
Mailing Address - Country:US
Mailing Address - Phone:406-600-4408
Mailing Address - Fax:
Practice Address - Street 1:103 MOON CIRCLE DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-1508
Practice Address - Country:US
Practice Address - Phone:406-600-4408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-634611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical