Provider Demographics
NPI:1366129538
Name:BUILDING BLOCKS SPEECH THERAPY LLC
Entity type:Organization
Organization Name:BUILDING BLOCKS SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHACKLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-415-3611
Mailing Address - Street 1:605 BELMONT DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-0136
Mailing Address - Country:US
Mailing Address - Phone:605-415-3611
Mailing Address - Fax:
Practice Address - Street 1:605 BELMONT DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-0136
Practice Address - Country:US
Practice Address - Phone:605-415-3611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty