Provider Demographics
NPI:1154133999
Name:NILLES, MEADOW S (CLINICIAN)
Entity type:Individual
Prefix:
First Name:MEADOW
Middle Name:S
Last Name:NILLES
Suffix:
Gender:F
Credentials:CLINICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 AVENUE D STE C
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3043
Mailing Address - Country:US
Mailing Address - Phone:406-272-2511
Mailing Address - Fax:406-204-0474
Practice Address - Street 1:1645 AVENUE D STE C
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3043
Practice Address - Country:US
Practice Address - Phone:406-272-2511
Practice Address - Fax:406-204-0474
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-703431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical