Madeline Feenstra

Individual provider Active NPI Speech-Language Pathologist · Rathdrum, ID

NPI 1003686288 · NPPES record last updated Jan 8, 2024

Key facts

NPI
1003686288
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
Practice address
8052 W Main St
Rathdrum, ID 83858-4916
Phone
(208) 503-6173
Fax
(208) 712-6808
NPI assigned
Jan 8, 2024
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Villa Pediatric Therapy LLC Speech-Language Pathologist Current
since Jan 14, 2024
Accepting new patients

Locations

8052 W Main St
Rathdrum, ID 83858
Phone (208) 503-6173

14375 N Rockwood Ct
Rathdrum, ID 83858

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist
Group: 193200000X MULTI-SPECIALTY GROUP
235Z00000X Yes

Addresses

Primary practice location

8052 W Main St
Rathdrum, ID 83858-4916

Mailing address

PO Box 793
Rathdrum, ID 83858-0793

Other names

  • Miss Madeline Poortinga Former name

Other providers in Rathdrum, ID

All providers in Rathdrum, ID · Speech-Language Pathologist in Idaho

Sources for this page

Verify at the official NPI Registry.