Healthcare Provider Details

I. General information

NPI: 1457264475
Provider Name (Legal Business Name): CAMBRIA PHOENIX SLETTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 N 19TH AVE
BOZEMAN MT
59718-3981
US

IV. Provider business mailing address

219 N 19TH AVE
BOZEMAN MT
59718-3981
US

V. Phone/Fax

Practice location:
  • Phone: 406-570-3088
  • Fax: 406-536-8233
Mailing address:
  • Phone: 406-570-3088
  • Fax: 406-536-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: