Individual provider Active NPI

Treasa Glinnwater, LCSW

  • Clinical Social Worker
  • Missoula, MT
National Provider Identifier
1154443612
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
178 Issued in MT
Practice address
126 E Broadway St
Missoula, MT 59802-4511
Phone
(406) 549-7104
Fax
(406) 542-2785
NPI assigned
Apr 4, 2007
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 178 MT Primary

Addresses

Primary practice location

126 E Broadway St
Missoula, MT 59802-4511

Mailing address

126 E Broadway St
Missoula, MT 59802-4511
Phone (406) 549-7104

Other identifiers 2

IdentifierTypeStateIssuer
178OtherMTSTATE LICENSE
0500747MedicaidMT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101227000267 MT Practitioner - Clinical Social Worker 8426246026 Practice locations: Missoula, MT; Polson, MT

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

126 E Broadway
Suite 4
Missoula, MT 59802-4511
Phone (406) 270-9225

314 1St St E
Suite 206
Polson, MT 59860-2100
Phone (406) 270-9225

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
178MTMDOccupational Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1154443612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 E BROADWAY ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024511",
            "telephone_number": "406-549-7104",
            "fax_number": "406-542-2785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 E BROADWAY ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024511",
            "telephone_number": "406-549-7104",
            "fax_number": "406-542-2785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLINNWATER",
        "first_name": "TREASA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-04",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MT",
            "license": "178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "178",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0500747",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.