Provider Demographics
NPI:1609080001
Name:FORT HAYS STATE UNIVERSITY
Entity Type:Organization
Organization Name:FORT HAYS STATE UNIVERSITY
Other - Org Name:HERNDON CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:KARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-SLP
Authorized Official - Phone:785-628-5366
Mailing Address - Street 1:600 PARK ST
Mailing Address - Street 2:HERNDON CLINIC ALBERTSON HALL 131
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-4009
Mailing Address - Country:US
Mailing Address - Phone:785-628-5366
Mailing Address - Fax:785-628-5271
Practice Address - Street 1:600 PARK ST
Practice Address - Street 2:HERNDON CLINIC ALBERTSON HALL 131
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4009
Practice Address - Country:US
Practice Address - Phone:785-628-5366
Practice Address - Fax:785-628-5271
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-09
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS116208OtherBLUE CROSS BLUE SHIELD