Bonny Jean Wolfe

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

BBH-ACLC-LIC-79239 Issued in MT

Practice address

414 1St St E Ste F
Polson, MT 59860-2153

Phone

(406) 505-4377

NPI assigned

Apr 25, 2025

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1745539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745539200000",
    "number": "1972391415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 295",
            "city": "RONAN",
            "state": "MT",
            "postal_code": "598640295",
            "telephone_number": "406-203-8180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 1ST ST E STE F",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598602153",
            "telephone_number": "406-505-4377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLFE",
        "first_name": "BONNY",
        "middle_name": "JEAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-04-25",
        "last_updated": "2025-04-25",
        "certification_date": "2025-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MT",
            "license": "BBH-ACLC-LIC-79239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Use Disorder Rehabilitation Clinic/Center in Polson, MT
• Providers in Polson, MT by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.