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General NPI Number Information
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NPI Number | 1700020039
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Entity Type | Individual
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Provider Name | SHELLY AMBER BODENSTEINER M.A. CCC-A
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Gender | Female
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Dates
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Enumeration Date | 04/30/2009
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Last Update Date | 04/30/2009
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Provider Practice Location Address
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Address Line | 947 W 47 HWY
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City | GIRARD
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State | KS
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Zip | 66743-2347
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Country | US
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Telephone | 620-724-6281
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Fax | 620-724-7243
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Provider Business Mailing Address
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Address Line | 947 W 47 HWY PO BOX 189
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City | GIRARD
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State | KS
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Zip | 66743-2347
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Country | US
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Telephone | 620-724-6281
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Fax | 620-724-7243
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 1954
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License Number State | KS
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