Provider Demographics
NPI:1306057583
Name:BOCK, CHUCK E (MA-CCC SLP)
Entity type:Individual
Prefix:MR
First Name:CHUCK
Middle Name:E
Last Name:BOCK
Suffix:
Gender:M
Credentials:MA-CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3952
Mailing Address - Country:US
Mailing Address - Phone:406-452-4202
Mailing Address - Fax:
Practice Address - Street 1:2225 1ST AVE S
Practice Address - Street 2:1101 26TH STREET SO
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3952
Practice Address - Country:US
Practice Address - Phone:406-452-4202
Practice Address - Fax:406-452-4202
Is Sole Proprietor?:No
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT16235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist