Provider Demographics
NPI:1619183282
Name:BATEMAN, ANGELA (MA-CCC-A)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:MA-CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 FAIRMOUNT ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67260-0099
Mailing Address - Country:US
Mailing Address - Phone:316-978-3289
Mailing Address - Fax:316-978-7264
Practice Address - Street 1:5015 E 29TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2110
Practice Address - Country:US
Practice Address - Phone:316-978-3289
Practice Address - Fax:316-978-7264
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1945231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS115720OtherBCBS
KS14144OtherPHS