Healthcare Provider Details

I. General information

NPI: 1366129538
Provider Name (Legal Business Name): BUILDING BLOCKS SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 BELMONT DR
RAPID CITY SD
57702-0136
US

IV. Provider business mailing address

605 BELMONT DR
RAPID CITY SD
57702-0136
US

V. Phone/Fax

Practice location:
  • Phone: 605-415-3611
  • Fax:
Mailing address:
  • Phone: 605-415-3611
  • 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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: LYNDA SHACKLETON
Title or Position: OWNER
Credential:
Phone: 605-415-3611