MEDICARE: MARY ELLEN ZIC M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2022012194	MO
2	235Z00000X	Speech-Language Pathologist	5701	KS

General Provider Information

NPI Number	:	1407795719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELLEN ZIC M.A.

Provider Business Mailing Address
First Line	:	641 E 72ND TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-1667
Country	:	US
Telephone Number	:	510-599-1389
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 W 95TH ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66206-2063
Country	:	US
Telephone Number	:	913-648-4500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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Directions to “ MARY ELLEN ZIC M.A.” Practice Location

Language	Start Address	Practice Location

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