Healthcare Provider Details

I. General information

NPI: 1831635911
Provider Name (Legal Business Name): GLENDA FELTS LMSW-33529
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 08/25/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR STE 130
COEUR D ALENE ID
83814-4404
US

IV. Provider business mailing address

940 W IRONWOOD DR STE A
RATHDRUM ID
83858
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-4700
  • Fax: 208-625-4701
Mailing address:
  • Phone: 208-687-0538
  • Fax: 208-712-6016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-42755
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: