Provider Demographics
NPI:1356816805
Name:BUILDING BLOCKS THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:BUILDING BLOCKS THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH AND LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOESEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:616-666-6396
Mailing Address - Street 1:600 3 MILE RD NW STE 102
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-1685
Mailing Address - Country:US
Mailing Address - Phone:616-666-6396
Mailing Address - Fax:
Practice Address - Street 1:600 3 MILE RD NW STE 102
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-1685
Practice Address - Country:US
Practice Address - Phone:616-666-6396
Practice Address - Fax:616-259-4207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1639584188Medicaid