Provider Demographics
NPI:1942364450
Name:STATE OF THE HEART THERAPY INC.
Entity type:Organization
Organization Name:STATE OF THE HEART THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:LEBAHN
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MCSD CCC-SLP
Authorized Official - Phone:406-683-5806
Mailing Address - Street 1:435 S ATLANTIC ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-2726
Mailing Address - Country:US
Mailing Address - Phone:406-683-5806
Mailing Address - Fax:406-683-5806
Practice Address - Street 1:435 S ATLANTIC ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-2726
Practice Address - Country:US
Practice Address - Phone:406-683-5806
Practice Address - Fax:406-683-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT066376OtherBCBS OF MONTANA
MT0000533630Medicaid