Provider Demographics
NPI:1942353081
Name:EGELAND, CAROL (CCC-SPEECH)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:EGELAND
Suffix:
Gender:F
Credentials:CCC-SPEECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 S HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-2121
Mailing Address - Country:US
Mailing Address - Phone:406-251-3289
Mailing Address - Fax:
Practice Address - Street 1:2317 S HILLS DR
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-2121
Practice Address - Country:US
Practice Address - Phone:406-251-3289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT534664Medicaid