Provider Demographics
NPI:1831727585
Name:ROCKFORD SPEECH THERAPY, LLC
Entity type:Organization
Organization Name:ROCKFORD SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLETZKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-951-1077
Mailing Address - Street 1:345 1/2 SIGSBEE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1029
Mailing Address - Country:US
Mailing Address - Phone:602-881-1753
Mailing Address - Fax:
Practice Address - Street 1:117 COURTLAND ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1031
Practice Address - Country:US
Practice Address - Phone:616-951-1077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty