Provider Demographics
NPI:1235588534
Name:BASSETT, KAY SULLIVAN (HIS)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:SULLIVAN
Last Name:BASSETT
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:CARLETTA
Other - Middle Name:KAY
Other - Last Name:BASSETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:1112 W 6TH ST
Mailing Address - Street 2:STE 216
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2215
Mailing Address - Country:US
Mailing Address - Phone:785-841-1107
Mailing Address - Fax:785-841-1173
Practice Address - Street 1:1112 W 6TH ST
Practice Address - Street 2:STE 216
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2215
Practice Address - Country:US
Practice Address - Phone:785-841-1107
Practice Address - Fax:785-841-1173
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1645237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201157650AMedicaid