Provider Demographics
NPI:1386706976
Name:PURKETT, JOSEPH CHARLES (MA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:CHARLES
Last Name:PURKETT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GARDNER PARK DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-9229
Mailing Address - Country:US
Mailing Address - Phone:406-587-1651
Mailing Address - Fax:
Practice Address - Street 1:40 GARDNER PARK DR
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-9229
Practice Address - Country:US
Practice Address - Phone:406-587-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT75235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist