Provider Demographics
NPI:1821688490
Name:SOUTH CENTRAL KANSAS LEARNING ACADEMY - SPEECH LANGUAGE PATHOLOGY
Entity Type:Organization
Organization Name:SOUTH CENTRAL KANSAS LEARNING ACADEMY - SPEECH LANGUAGE PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-214-5416
Mailing Address - Street 1:3511 E 73RD CIR N
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67147-9235
Mailing Address - Country:US
Mailing Address - Phone:316-214-5416
Mailing Address - Fax:
Practice Address - Street 1:3511 E 73RD CIR N
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67147-9235
Practice Address - Country:US
Practice Address - Phone:316-214-5416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech