Provider Demographics
NPI:1245247923
Name:HAVERLY-FELTEN, SHIRLEY (MA)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:HAVERLY-FELTEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-2434
Mailing Address - Country:US
Mailing Address - Phone:563-243-2285
Mailing Address - Fax:563-243-2293
Practice Address - Street 1:2320 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-2434
Practice Address - Country:US
Practice Address - Phone:563-243-2285
Practice Address - Fax:563-243-2293
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01467235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01467OtherLICENSE
IA01467OtherLICENSE
IA0665265Medicaid