=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285747436
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN SEAVERTSON PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4801 E LINWOOD BLVD AUDIOLOGY 126
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64128-2226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-922-2150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10555 KILL CREEK RD
-----------------------------------------------------
City | DE SOTO
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66018-9500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-585-3324
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | HD00980
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------