Provider Demographics
NPI:1851503585
Name:PRIEST, MASON S (HIS)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:S
Last Name:PRIEST
Suffix:
Gender:M
Credentials:HIS
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 3
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:KS
Mailing Address - Zip Code:66552-0003
Mailing Address - Country:US
Mailing Address - Phone:785-873-3142
Mailing Address - Fax:
Practice Address - Street 1:413 THIRD ST
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:KS
Practice Address - Zip Code:66552-0003
Practice Address - Country:US
Practice Address - Phone:785-873-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1095237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist