Healthcare Provider Details

I. General information

NPI: 1790083780
Provider Name (Legal Business Name): RYANN KUYKENDALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E TRUMAN RD ROOM 349
KANSAS CITY MO
64106-3152
US

IV. Provider business mailing address

1215 E TRUMAN RD ROOM 349
KANSAS CITY MO
64106-3152
US

V. Phone/Fax

Practice location:
  • Phone: 816-418-5238
  • Fax: 816-418-5239
Mailing address:
  • Phone: 816-418-5238
  • Fax: 816-418-5239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2010028671
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: