Provider Demographics
NPI:1891996146
Name:REISS, PATRICIA E (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E
Last Name:REISS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13401 184TH ST
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66052-4604
Mailing Address - Country:US
Mailing Address - Phone:913-832-7925
Mailing Address - Fax:913-723-3422
Practice Address - Street 1:13401 184TH ST
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:KS
Practice Address - Zip Code:66052-4604
Practice Address - Country:US
Practice Address - Phone:913-832-7925
Practice Address - Fax:913-723-3422
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1739235Z00000X
MO1999138400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist