Provider Demographics
NPI:1487011003
Name:GREENSLADE, JAMES WALTER (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WALTER
Last Name:GREENSLADE
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 WALNUT ST APT 1902
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-2027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15301 W 87TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1401
Practice Address - Country:US
Practice Address - Phone:913-492-4888
Practice Address - Fax:913-492-4741
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3876235Z00000X
MO2015038134235Z00000X
ARSP#2911235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist