Provider Demographics
NPI:1255571964
Name:SPEECH SWALLOWING AND VOICE CENTER PA
Entity type:Organization
Organization Name:SPEECH SWALLOWING AND VOICE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:316-573-6802
Mailing Address - Street 1:13213 W 21ST CT STE 104
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-9625
Mailing Address - Country:US
Mailing Address - Phone:316-573-6802
Mailing Address - Fax:316-721-2291
Practice Address - Street 1:13213 W 21ST CT STE 104
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-9625
Practice Address - Country:US
Practice Address - Phone:316-573-6802
Practice Address - Fax:316-721-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1412235Z00000X
KS2627235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30003885570001Medicaid
KS30003885570006Medicaid
KS30003885570005Medicaid