Provider Demographics
NPI:1972046605
Name:CRUSE, LORA D (HIS)
Entity Type:Individual
Prefix:MRS
First Name:LORA
Middle Name:D
Last Name:CRUSE
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 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:316-108-0183
Mailing Address - Fax:316-685-7926
Practice Address - Street 1:356 N ROCK RD
Practice Address - Street 2:SUITE B
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2282
Practice Address - Country:US
Practice Address - Phone:316-681-7446
Practice Address - Fax:316-685-7926
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1553237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist