Provider Demographics
NPI:1124165360
Name:MCKINNON, ROSEMARY EILEEN (MSW)
Entity type:Individual
Prefix:MR
First Name:ROSEMARY
Middle Name:EILEEN
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 ORCHARD RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-7565
Mailing Address - Country:US
Mailing Address - Phone:406-752-8408
Mailing Address - Fax:
Practice Address - Street 1:28 W CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3927
Practice Address - Country:US
Practice Address - Phone:406-752-8408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT237101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health