Provider Demographics
NPI:1144758988
Name:RUSHMORE KIDS SPEECH THERAPY INC
Entity Type:Organization
Organization Name:RUSHMORE KIDS SPEECH THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSY WATHEN
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WATHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:605-209-2246
Mailing Address - Street 1:13232 KLONDIKE RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-7426
Mailing Address - Country:US
Mailing Address - Phone:605-209-2246
Mailing Address - Fax:
Practice Address - Street 1:13232 KLONDIKE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-7426
Practice Address - Country:US
Practice Address - Phone:605-209-2246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty