Provider Demographics
NPI:1609202753
Name:SADLER, KEVIN D
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:SADLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5516 NE ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119
Mailing Address - Country:US
Mailing Address - Phone:816-389-5999
Mailing Address - Fax:
Practice Address - Street 1:105 N CLAYVIEW DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1116
Practice Address - Country:US
Practice Address - Phone:816-389-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012036610237700000X
KS1602237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012036610OtherHEARING AID DISPENSER LICENSE