Provider Demographics
NPI:1801879432
Name:PARK, KAY RABBITT (AUD)
Entity type:Individual
Prefix:MS
First Name:KAY
Middle Name:RABBITT
Last Name:PARK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9888 OLD WARSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1068
Mailing Address - Country:US
Mailing Address - Phone:314-251-4847
Mailing Address - Fax:314-251-5992
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:314-251-4847
Practice Address - Fax:314-251-5992
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1053231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO3923C1OtherBLUE CROSS BLUE SHEILD-PP
MO152209OtherBLUE CHOICE-HMO
MO3923C2OtherBCBS-PPO WASHINGTON
MO33336410Medicaid
MOP47187Medicare UPIN