Provider Demographics
NPI:1023438314
Name:DIPASQUALE, PRISCILLA RAYBURN (MS)
Entity type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:RAYBURN
Last Name:DIPASQUALE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12217 FARLEY ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1686
Mailing Address - Country:US
Mailing Address - Phone:913-481-3136
Mailing Address - Fax:888-652-9198
Practice Address - Street 1:6700 ANTIOCH RD
Practice Address - Street 2:SUITE 120
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-1497
Practice Address - Country:US
Practice Address - Phone:913-652-9229
Practice Address - Fax:888-652-9198
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS243235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist