Provider Demographics
NPI:1760968861
Name:CAVENEE, MARIAH JEANNE
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:JEANNE
Last Name:CAVENEE
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:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:TRIBUNE
Mailing Address - State:KS
Mailing Address - Zip Code:67879-0670
Mailing Address - Country:US
Mailing Address - Phone:620-376-2080
Mailing Address - Fax:620-376-2083
Practice Address - Street 1:107 W GREELEY AVE
Practice Address - Street 2:
Practice Address - City:TRIBUNE
Practice Address - State:KS
Practice Address - Zip Code:67879-7711
Practice Address - Country:US
Practice Address - Phone:620-376-2080
Practice Address - Fax:620-376-2083
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1737237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist