Provider Demographics
NPI:1063019297
Name:MOMENTUM SPEECH THERAPY, PC
Entity Type:Organization
Organization Name:MOMENTUM SPEECH THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALTENHOFEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS/SLP
Authorized Official - Phone:406-360-8352
Mailing Address - Street 1:9885 O'BRIEN CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804
Mailing Address - Country:US
Mailing Address - Phone:406-360-8352
Mailing Address - Fax:406-543-3125
Practice Address - Street 1:9885 O'BRIEN CREEK ROAD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804
Practice Address - Country:US
Practice Address - Phone:406-360-8352
Practice Address - Fax:406-543-3125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty