Provider Demographics
NPI:1386262046
Name:SCALLY, SHANNON ST ONGE (DNP)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ST ONGE
Last Name:SCALLY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-1239
Mailing Address - Country:US
Mailing Address - Phone:406-360-5093
Mailing Address - Fax:406-720-7944
Practice Address - Street 1:SCALLY PSYCHIATRIC MENTAL HEALTH
Practice Address - Street 2:2431 RIVER ROAD
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-1239
Practice Address - Country:US
Practice Address - Phone:406-360-5093
Practice Address - Fax:406-720-7944
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT195702363LP0808X
MT27210390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT$$$$$$$$$OtherNA