Healthcare Provider Details

I. General information

NPI: 1184514549
Provider Name (Legal Business Name): ELLIE CAROLINE VAN SICKLE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 NE GOODVIEW CIR
LEES SUMMIT MO
64064-1996
US

IV. Provider business mailing address

5101 COLLEGE BLVD
LEAWOOD KS
66211-1614
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-4200
  • Fax: 816-875-2597
Mailing address:
  • Phone: 913-721-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2561
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2026026015
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: