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General NPI Number Information
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NPI Number | 1578451308
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE SPEECH THERAPY PLLC
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Dates
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Enumeration Date | 06/27/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 2126 DIXON AVE
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City | MISSOULA
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State | MT
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Zip | 59801-8226
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Country | US
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Telephone | 406-282-0508
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Fax |
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Provider Business Mailing Address
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Address Line | 2240 E VISTA DR
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City | MISSOULA
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State | MT
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Zip | 59803-2616
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MELISSA PHELAN
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Credential | PHD, CCC-SLP
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Telephone | 406-282-0508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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