Provider Demographics
NPI:1609959592
Name:SAGE, IRMA (BC-HIS)
Entity Type:Individual
Prefix:MRS
First Name:IRMA
Middle Name:
Last Name:SAGE
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10318 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-3135
Mailing Address - Country:US
Mailing Address - Phone:316-558-5100
Mailing Address - Fax:316-453-3487
Practice Address - Street 1:10318 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-3135
Practice Address - Country:US
Practice Address - Phone:316-558-5100
Practice Address - Fax:316-453-3487
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1113237700000X
KS1233237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist