Provider Demographics
NPI:1356982912
Name:UNRUH, JUSTINE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:UNRUH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E WHEATRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-8989
Mailing Address - Country:US
Mailing Address - Phone:316-836-4700
Mailing Address - Fax:316-836-4750
Practice Address - Street 1:510 E WHEATRIDGE DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-8989
Practice Address - Country:US
Practice Address - Phone:316-836-4700
Practice Address - Fax:316-836-4750
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4131235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist