Provider Demographics
NPI:1942634530
Name:CRUSE, MONTY C JR
Entity Type:Individual
Prefix:MR
First Name:MONTY
Middle Name:C
Last Name:CRUSE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 E SKINNER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-4054
Mailing Address - Country:US
Mailing Address - Phone:316-789-5980
Mailing Address - Fax:316-721-5995
Practice Address - Street 1:4800 W MAPLE ST
Practice Address - Street 2:STE. 115
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2563
Practice Address - Country:US
Practice Address - Phone:316-945-9200
Practice Address - Fax:316-942-2995
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1554237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist