Provider Demographics
NPI:1710195847
Name:MABE, DENISE (MA-CCC SLP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MABE
Suffix:
Gender:F
Credentials:MA-CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 N ROCK RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1262
Mailing Address - Country:US
Mailing Address - Phone:316-634-3480
Mailing Address - Fax:
Practice Address - Street 1:1151 N ROCK RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1262
Practice Address - Country:US
Practice Address - Phone:316-634-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS579235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist