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General NPI Number Information
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NPI Number | 1144758988
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Entity Type | Organization
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Legal Business Name | RUSHMORE KIDS SPEECH THERAPY INC
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Dates
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Enumeration Date | 05/24/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 13232 KLONDIKE RD
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City | RAPID CITY
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State | SD
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Zip | 57702-7426
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Country | US
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Telephone | 605-209-2246
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Fax |
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Provider Business Mailing Address
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Address Line | 13232 KLONDIKE RD
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City | RAPID CITY
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State | SD
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Zip | 57702-7426
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Country | US
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Telephone | 605-209-2246
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LINDSY WATHEN JO WATHEN
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Credential | MA, CCC-SLP
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Telephone | 605-209-2246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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