Basic Information
| Provider Information | |||||||||
| NPI: | 1619598141 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELLMAN | ||||||||
| FirstName: | ANGELA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3864 STEBNER RD | ||||||||
| Address2: | |||||||||
| City: | HERMANTOWN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558111734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183402066 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 8TH ST SE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559047339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072886514 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2020 | ||||||||
| LastUpdateDate: | 05/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.