Provider Demographics
NPI:1255108445
Name:WHITEMAN, JACQUELINE (LCSW)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:WHITEMAN
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 1:1223 N CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034-1100
Mailing Address - Country:US
Mailing Address - Phone:406-294-0044
Mailing Address - Fax:406-867-4103
Practice Address - Street 1:1223 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:MT
Practice Address - Zip Code:59034-1100
Practice Address - Country:US
Practice Address - Phone:406-665-4103
Practice Address - Fax:406-861-4103
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-665481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical