Provider Demographics
NPI:1750560611
Name:NIEMANN, AUDREY CHRISTINE (MS CCC SLP)
Entity type:Individual
Prefix:MISS
First Name:AUDREY
Middle Name:CHRISTINE
Last Name:NIEMANN
Suffix:
Gender:F
Credentials:MS 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:PO BOX 525
Mailing Address - Street 2:1405 WEST GRAND AVENUE
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429
Mailing Address - Country:US
Mailing Address - Phone:816-632-2151
Mailing Address - Fax:816-632-2999
Practice Address - Street 1:1405 WEST GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429
Practice Address - Country:US
Practice Address - Phone:816-632-2151
Practice Address - Fax:816-632-2999
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007012832235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist