Provider Demographics
NPI:1235353574
Name:KIDDER, GARY H (BC-HIS,MCAP)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:H
Last Name:KIDDER
Suffix:
Gender:M
Credentials:BC-HIS,MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 17TH ST W STE 102
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-1724
Mailing Address - Country:US
Mailing Address - Phone:406-252-4731
Mailing Address - Fax:406-252-7698
Practice Address - Street 1:2520 17TH ST W STE 102
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-1724
Practice Address - Country:US
Practice Address - Phone:406-252-4731
Practice Address - Fax:406-252-7698
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT290235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist