Provider Demographics
NPI:1861785172
Name:TRONSTAD, MARIANNE MOON
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:MOON
Last Name:TRONSTAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 WINCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-4551
Mailing Address - Country:US
Mailing Address - Phone:406-549-0363
Mailing Address - Fax:
Practice Address - Street 1:1525 WINCHESTER CT
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-4551
Practice Address - Country:US
Practice Address - Phone:406-549-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT981041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool