Provider Demographics
NPI:1376148999
Name:BITTERROOT SPEECH & LANGUAGE SERVICES, LLC
Entity Type:Organization
Organization Name:BITTERROOT SPEECH & LANGUAGE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:406-529-2795
Mailing Address - Street 1:475 WINES WAY
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-6060
Mailing Address - Country:US
Mailing Address - Phone:406-529-2795
Mailing Address - Fax:406-493-6505
Practice Address - Street 1:475 WINES WAY
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-6060
Practice Address - Country:US
Practice Address - Phone:406-529-2795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1750993549Medicaid