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NPI Code Detail

MEDICARE: BUILDING BLOCKS THERAPY SERVICES, LLC

MEDICARE: BUILDING BLOCKS THERAPY SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356816805
Entity Type Code : Organization
Provider Name (Legal Business Name) : BUILDING BLOCKS THERAPY SERVICES, LLC
Provider Business Mailing Address
First Line : 600 3 MILE RD NW STE 102
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49544-1685
Country : US
Telephone Number : 616-666-6396
Fax Number :
Provider Business Practice Location Address
First Line : 600 3 MILE RD NW STE 102
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49544-1685
Country : US
Telephone Number : 616-666-6396
Fax Number : 616-259-4207
Authorized Official
Title or Position : SPEECH AND LANGUAGE PATHOLOGIST
Name : COURTNEY JOESEL
Credential : MA CCC-SLP
Telephone Number : 616-666-6396
Provider Enumeration Date : 10/11/2018
Last Update Date : 10/11/2018

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Directions to “BUILDING BLOCKS THERAPY SERVICES, LLC ” Practice Location

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