Provider Demographics
NPI:1659409126
Name:RUBENACKER, KENNETH WAYNE (MS, CCC-A)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:WAYNE
Last Name:RUBENACKER
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 S KINGSHIGHWAY ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-2923
Mailing Address - Country:US
Mailing Address - Phone:573-471-7264
Mailing Address - Fax:573-471-7264
Practice Address - Street 1:417 SOUTH KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-2923
Practice Address - Country:US
Practice Address - Phone:573-471-7264
Practice Address - Fax:573-471-7264
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01570231H00000X
MO000803237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO45-00333OtherUNITED HEALTHCARE
MO121820OtherBLUE CROSS BLUE SHIELD
MO531661OtherHEALTHLINK