Provider Demographics
NPI:1538589924
Name:FLAHERTY, CAROL (SLP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:BISHOP
Other - Last Name:FLAHERTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:1303 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5607
Mailing Address - Country:US
Mailing Address - Phone:406-219-2208
Mailing Address - Fax:
Practice Address - Street 1:1303 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5607
Practice Address - Country:US
Practice Address - Phone:406-219-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2016-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-SP-LIC-4188235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist