Provider Demographics
NPI:1093951170
Name:ALLENBACH, STACY R (AUD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:R
Last Name:ALLENBACH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:R
Other - Last Name:KERSCHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9102
Practice Address - Street 1:1947 FOUNDERS' CIRCLE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206
Practice Address - Country:US
Practice Address - Phone:316-613-4695
Practice Address - Fax:316-613-4940
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2165231H00000X
KS1436231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist