Healthcare Provider Details

I. General information

NPI: 1154014843
Provider Name (Legal Business Name): GREAT FALLS SCOTTISH RITE CHILDHOOD LANGUAGE DISORDERS CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 13TH ST S
GREAT FALLS MT
59405-4611
US

IV. Provider business mailing address

1304 13TH ST S
GREAT FALLS MT
59405-4611
US

V. Phone/Fax

Practice location:
  • Phone: 406-727-1088
  • Fax:
Mailing address:
  • Phone: 406-250-1459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOLLY BECK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 406-727-1088