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General NPI Number Information
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NPI Number | 1942443296
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Entity Type | Organization
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Legal Business Name | KANSAS SPEECH THERAPY LLC
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Dates
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Enumeration Date | 04/16/2009
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 1532 N WALNUT ST
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City | MCPHERSON
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State | KS
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Zip | 67460-1824
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Country | US
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Telephone | 620-480-9320
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Fax | 620-210-6984
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Provider Business Mailing Address
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Address Line | 1532 N WALNUT ST
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City | MCPHERSON
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State | KS
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Zip | 67460-1824
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Country | US
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Telephone | 620-480-9320
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Fax | 620-210-6984
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Authorized Official
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Title or Position | OPERATING MANAGER
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Name | MIKE BERGER
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Credential |
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Telephone | 620-480-9320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2063
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License Number State | KS
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