Provider Demographics
NPI:1730204652
Name:KLINGAMAN, BOBBI JO (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BOBBI
Middle Name:JO
Last Name:KLINGAMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:BOBBI
Other - Middle Name:JO
Other - Last Name:BUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 992
Mailing Address - Street 2:525 PENNSYLVANIA STREET
Mailing Address - City:CHINOOK
Mailing Address - State:MT
Mailing Address - Zip Code:59523-0992
Mailing Address - Country:US
Mailing Address - Phone:406-945-3717
Mailing Address - Fax:
Practice Address - Street 1:525 PENNSYLVANIA STREET
Practice Address - Street 2:
Practice Address - City:CHINOOK
Practice Address - State:MT
Practice Address - Zip Code:59523-0922
Practice Address - Country:US
Practice Address - Phone:406-945-3717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT728101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT71415OtherBLUE CROSS BLUE SHIELD
MT0503880Medicaid