MEDICARE: MARLA S. STAAB CCC-SLP

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	589	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BCBS	OTHER	KS	115423

General Provider Information

NPI Number	:	1528155934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLA S. STAAB CCC-SLP

Provider Business Mailing Address
First Line	:	600 PARK ST
Second Line	:	ALBERTSON HALL 135
City	:	HAYS
State	:	KS
Zip	:	67601-4009
Country	:	US
Telephone Number	:	785-628-4450
Fax Number	:	785-628-5271

Provider Business Practice Location Address
First Line	:	600 PARK ST
Second Line	:	ALBERTSON HALL 135
City	:	HAYS
State	:	KS
Zip	:	67601-4009
Country	:	US
Telephone Number	:	785-628-4450
Fax Number	:	785-628-5271

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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Directions to “ MARLA S. STAAB CCC-SLP” Practice Location

Language	Start Address	Practice Location

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