Provider Demographics
NPI:1962624726
Name:SHORT, STEVEN JOHN (SLP)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOHN
Last Name:SHORT
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 32ND ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5300
Mailing Address - Country:US
Mailing Address - Phone:406-761-4300
Mailing Address - Fax:406-761-8882
Practice Address - Street 1:1500 32ND ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5300
Practice Address - Country:US
Practice Address - Phone:406-761-4300
Practice Address - Fax:406-761-8882
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT682Medicaid