NPIMap

Organization Active NPI

Rockford Speech Therapy, LLC

  • Speech-Language Pathologist
  • Rockford, MI
National Provider Identifier
1831727585
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
ROCKFORD SPEECH THERAPY, LLC
Practice address
117 Courtland St
Rockford, MI 49341-1031
Phone
(616) 951-1077
NPI assigned
Mar 30, 2020
Last updated
Mar 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marissa DoletzkyNPI 1245786227
Title
Speech Therapist/Owner
Phone
(616) 951-1077

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X NU Primary

Addresses

Primary practice location

117 Courtland St
Rockford, MI 49341-1031

Mailing address

345 1/2 Sigsbee St
Rockford, MI 49341-1029
Phone (602) 881-1753

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210324002145 MI Part B Supplier - Clinic/Group Practice 6002223781 Receives reassigned benefits from 2 practitioners
Practice locations: Belmont, MI; Grand Rapids, MI; Rockford, MI

National Provider Directory

National Provider Directory

Locations

6284 Belmont Ave NE
Ste A
Belmont, MI 49306
Phone (616) 951-1077

117 Courtland St
Rockford, MI 49341
Phone (616) 835-9211

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616371200000",
    "number": "1831727585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 1/2 SIGSBEE ST",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493411029",
            "telephone_number": "602-881-1753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 COURTLAND ST",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493411031",
            "telephone_number": "616-951-1077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKFORD SPEECH THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-30",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A",
        "authorized_official_last_name": "DOLETZKY",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_title_or_position": "SPEECH THERAPIST/OWNER",
        "authorized_official_telephone_number": "616-951-1077"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.