Provider Demographics
NPI:1881722361
Name:EUGENE F HERMAN SCOTTISH RITE CHILDHOOD LANGUAGE DISORDERS CLINIC
Entity type:Organization
Organization Name:EUGENE F HERMAN SCOTTISH RITE CHILDHOOD LANGUAGE DISORDERS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-259-1680
Mailing Address - Street 1:50 27TH ST W STE A
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-8602
Mailing Address - Country:US
Mailing Address - Phone:406-259-1680
Mailing Address - Fax:406-259-1777
Practice Address - Street 1:50 27TH ST W STE A
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-8602
Practice Address - Country:US
Practice Address - Phone:406-259-1680
Practice Address - Fax:406-259-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty