Marisa Sue Ridley, LCSW
Individual provider Active NPI Clinical Social Worker · Malmstrom Afb, MT
NPI 1104402155 · NPPES record last updated Oct 23, 2023
Key facts
- NPI
- 1104402155
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 65254 (TX)
- Practice address
- 7300 N Perimeter Rd
Malmstrom Afb, MT 59402-6701 - Phone
- (406) 731-3218
- NPI assigned
- Mar 21, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65254 | TX | MD | Clinical Social Worker |
| 11903428-3507 | UT | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 65254 | TX | Yes |
| Clinical Social Worker | 1041C0700X | 11903428-3507 | UT |
Addresses
Primary practice location
7300 N Perimeter Rd
Malmstrom Afb, MT 59402-6701
Mailing address
820 Ironwood St
Great Falls, MT 59405-7949
Phone (903) 821-7532
Other providers in Malmstrom Afb, MT
- Mercy Jean Padgett
- Dallin Page
- Terry Ken Pennington
- Trevor Allan Peterson
- John Robert Powell
- Misty Dawn Robertson
- Michael Rohan
- Fernando Santana
- Ryan Seymour
- Emily Skinner
All providers in Malmstrom Afb, MT · Clinical Social Worker in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.