Healthcare Provider Details

I. General information

NPI: 1821551292
Provider Name (Legal Business Name): STONERIDGE INVESTMENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 CANDLEWOOD DR
EMPORIA KS
66801-6653
US

IV. Provider business mailing address

11006 W TAYLOR CIR
WICHITA KS
67212-5483
US

V. Phone/Fax

Practice location:
  • Phone: 620-342-4327
  • Fax:
Mailing address:
  • Phone: 316-650-8343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GEVAN STOVER
Title or Position: PRACTICE OWNER
Credential: NBC-HIS
Phone: 316-650-8343