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Provider Information for 1659566495


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SHIRLEY SUE CAYKO LCSW


Sex: Female

NPI: 1659566495
Last Updated: 2015-01-30
Certification Date:

Details

NameValue
NPI1659566495
Enumeration Date2007-09-13
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address PO BOX 373
ULM, MT 59485-0373
United States

Phone: 406-268-1069 | Fax:
 
Primary Practice Address 1601 2ND AVE N STE 400
GREAT FALLS, MT 59401-3276
United States

Phone: 406-453-0088 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)MT0000701213Blue Cross/Blue Shield of MT
Other (non-Medicare)MT12501880CAQH
MEDICAIDMT1659566495
Other (non-Medicare)MTP00692129 C01340Railroad Medicare
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalMT803 LCSW