Provider Demographics
NPI:1902161920
Name:OPSTAD, TRICIA A (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:A
Last Name:OPSTAD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2451
Mailing Address - Country:US
Mailing Address - Phone:406-531-4249
Mailing Address - Fax:406-258-0638
Practice Address - Street 1:815 ELM STREET
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-2451
Practice Address - Country:US
Practice Address - Phone:406-531-4249
Practice Address - Fax:406-258-0638
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT 3161235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT332E6135E6Medicaid