Provider Demographics
NPI:1942224670
Name:FARRELL, JOHN M (MA, AUD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:FARRELL
Suffix:
Gender:M
Credentials:MA, AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 SAINT MATTHEW CIR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2227
Mailing Address - Country:US
Mailing Address - Phone:785-317-1286
Mailing Address - Fax:
Practice Address - Street 1:650 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:FT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-4030
Practice Address - Country:US
Practice Address - Phone:785-233-0500
Practice Address - Fax:785-239-7151
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2110 AUD 1251 HA237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200307580AMedicaid
KS115767OtherBLUE CROSS BLUE SHIELD
KS115767OtherBLUE CROSS BLUE SHIELD