Provider Demographics
NPI:1033515481
Name:ROCK CREEK TELETHERAPY, LLC
Entity Type:Organization
Organization Name:ROCK CREEK TELETHERAPY, LLC
Other - Org Name:ROCK CREEK THERAPY, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:DELAPP
Authorized Official - Last Name:COHN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:888-241-4332
Mailing Address - Street 1:1302 24TH ST W
Mailing Address - Street 2:SUITE 132
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3861
Mailing Address - Country:US
Mailing Address - Phone:888-241-4332
Mailing Address - Fax:406-794-0454
Practice Address - Street 1:1302 24TH ST W
Practice Address - Street 2:SUITE 132
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3861
Practice Address - Country:US
Practice Address - Phone:888-241-4332
Practice Address - Fax:406-794-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1286235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1033515481Medicaid