Healthcare Provider Details

I. General information

NPI: 1669599411
Provider Name (Legal Business Name): MARY BETH KOBZA HALLE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 JORDON DR
RAPID CITY SD
57702
US

IV. Provider business mailing address

1921 EVERGREEN DR
RAPID CITY SD
57702-3472
US

V. Phone/Fax

Practice location:
  • Phone: 605-342-4412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: