Healthcare Provider Details

I. General information

NPI: 1952211336
Provider Name (Legal Business Name): ADDISON CYPHERS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 METROPOLITAN AVE
LEAVENWORTH KS
66048-1124
US

IV. Provider business mailing address

1719 METROPOLITAN AVE
LEAVENWORTH KS
66048-1124
US

V. Phone/Fax

Practice location:
  • Phone: 913-250-5634
  • Fax:
Mailing address:
  • Phone: 913-250-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2841179
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: