Provider Demographics
NPI:1689256307
Name:FELTEN, CONRAD (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CONRAD
Middle Name:
Last Name:FELTEN
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 12TH AVE W STE 2A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-3855
Mailing Address - Country:US
Mailing Address - Phone:406-471-1117
Mailing Address - Fax:406-309-2076
Practice Address - Street 1:55 HERITAGE WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3100
Practice Address - Country:US
Practice Address - Phone:406-471-9910
Practice Address - Fax:406-309-2076
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-LTD-LIC-77235Z00000X
MT9656235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist