Provider Demographics
NPI:1821205899
Name:FERRELL, PATRICE M (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:M
Last Name:FERRELL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:PATRICE
Other - Middle Name:M
Other - Last Name:ARNZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-0188
Mailing Address - Country:US
Mailing Address - Phone:913-651-1000
Mailing Address - Fax:913-651-3030
Practice Address - Street 1:3400 S 4TH TRAFFICWAY
Practice Address - Street 2:SUITE C
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5012
Practice Address - Country:US
Practice Address - Phone:913-651-1000
Practice Address - Fax:913-651-3030
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1664235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS115721OtherBCBS OF KANSAS