Provider Demographics
NPI:1679785893
Name:SPECKHALS, JOHN M (AAPS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:SPECKHALS
Suffix:
Gender:M
Credentials:AAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 IOWA
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434
Mailing Address - Country:US
Mailing Address - Phone:785-741-2323
Mailing Address - Fax:
Practice Address - Street 1:1301 N 2ND STREET
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002
Practice Address - Country:US
Practice Address - Phone:913-367-1593
Practice Address - Fax:913-367-1627
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10110077AMedicaid