Provider Demographics
NPI:1396731626
Name:STATE OF KANSAS - ACCOUNTING SERVICES
Entity type:Organization
Organization Name:STATE OF KANSAS - ACCOUNTING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEGNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:785-864-4690
Mailing Address - Street 1:1200 SUNNYSIDE AVE
Mailing Address - Street 2:2101 HAWORTH HALL
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-7534
Mailing Address - Country:US
Mailing Address - Phone:785-864-4690
Mailing Address - Fax:785-864-5094
Practice Address - Street 1:1200 SUNNYSIDE AVENUE
Practice Address - Street 2:2101 HAWORTH HALL
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-7534
Practice Address - Country:US
Practice Address - Phone:785-864-4690
Practice Address - Fax:785-864-5094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1158231H00000X
KS00233235Z00000X
KS02138235Z00000X
KS02157235Z00000X
KS01870235Z00000X
KS00953235Z00000X
KS02297235Z00000X
KS00123235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100215990AMedicaid
KS011803OtherBCBS
KS100008080DMedicaid
KS018367Medicare ID - Type UnspecifiedSPEECH WEGNER
KS011803OtherBCBS
KS100008080DMedicaid
KS100215990AMedicaid