Provider Demographics
NPI:1912197948
Name:CHARLA DEITER
Entity Type:Organization
Organization Name:CHARLA DEITER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DEITER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:620-442-8700
Mailing Address - Street 1:1711 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-1607
Mailing Address - Country:US
Mailing Address - Phone:620-442-8700
Mailing Address - Fax:
Practice Address - Street 1:7733 FORSYTH BLVD STE 1700
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1801
Practice Address - Country:US
Practice Address - Phone:800-677-1238
Practice Address - Fax:314-863-0769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2434314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility