Provider Demographics
NPI:1912788332
Name:FELTY, EMMA
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:FELTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5406 MERLE HAY RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1209
Mailing Address - Country:US
Mailing Address - Phone:515-727-8750
Mailing Address - Fax:515-727-8757
Practice Address - Street 1:1915 PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8768
Practice Address - Country:US
Practice Address - Phone:515-598-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA118280103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst