Provider Demographics
NPI:1497034490
Name:GARDNER-ROSICA, KATHRYN (MED-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:GARDNER-ROSICA
Suffix:
Gender:F
Credentials:MED-SLP
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:M
Other - Last Name:GARDNER-ROSICA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED-SLP
Mailing Address - Street 1:6701 W 121ST ST STE 1&2
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2003
Mailing Address - Country:US
Mailing Address - Phone:913-320-2266
Mailing Address - Fax:
Practice Address - Street 1:6701 W 121ST ST STE 1&2
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209
Practice Address - Country:US
Practice Address - Phone:913-469-4210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006362235Z00000X
KS3897235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist