Provider Demographics
NPI:1184674202
Name:RANCK, MISTI M (MS)
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:M
Last Name:RANCK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 W 6TH ST STE 216
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2249
Mailing Address - Country:US
Mailing Address - Phone:785-841-1107
Mailing Address - Fax:785-830-6300
Practice Address - Street 1:1112 W 6TH ST STE 216
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2249
Practice Address - Country:US
Practice Address - Phone:785-841-1107
Practice Address - Fax:785-830-6300
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE183231H00000X
KS2145231H00000X
KS1400237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47078557568Medicaid
NES87898Medicare UPIN
NE47078557568Medicaid