Provider Demographics
NPI:1386793289
Name:WEBBER, PATRICIA LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LEE
Last Name:WEBBER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SW HIGGINS AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1341
Mailing Address - Country:US
Mailing Address - Phone:406-543-5872
Mailing Address - Fax:
Practice Address - Street 1:1001 SW HIGGINS AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1341
Practice Address - Country:US
Practice Address - Phone:406-543-5872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT134103G00000X, 103TC0700X, 103TF0200X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0493012Medicaid
MT50901OtherBLUE CROSS BLUE SHIELD
MT13-00395-9OtherMT STATE WORKMAN'S COMP.
MT50901OtherBLUE CROSS BLUE SHIELD