Provider Demographics
NPI:1710107073
Name:KEMPKER, ELAINE M
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
Last Name:KEMPKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026-1581
Mailing Address - Country:US
Mailing Address - Phone:573-392-8003
Mailing Address - Fax:573-392-8080
Practice Address - Street 1:ELDON R-I
Practice Address - Street 2:112 S PINE ST
Practice Address - City:ELDON
Practice Address - State:MO
Practice Address - Zip Code:65026-1581
Practice Address - Country:US
Practice Address - Phone:573-392-8003
Practice Address - Fax:573-392-8080
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00228235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO463131102Medicaid