Provider Demographics
NPI:1720368558
Name:WISSMANN, MARY K
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:WISSMANN
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 1:7703 NW BARRY RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-1731
Mailing Address - Country:US
Mailing Address - Phone:816-359-4050
Mailing Address - Fax:816-359-4059
Practice Address - Street 1:7703 NW BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-1731
Practice Address - Country:US
Practice Address - Phone:816-359-4050
Practice Address - Fax:816-359-4059
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112310235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist