Provider Demographics
NPI:1801974803
Name:TOURTILLOTT, JUSTIN A (AUD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:A
Last Name:TOURTILLOTT
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 SW 6TH AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66615-1004
Mailing Address - Country:US
Mailing Address - Phone:785-271-2284
Mailing Address - Fax:785-271-2286
Practice Address - Street 1:6001 SW 6TH AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615-1011
Practice Address - Country:US
Practice Address - Phone:785-271-2284
Practice Address - Fax:785-271-2286
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1996231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200579640AMedicaid
KS200579640AMedicaid
KS115704Medicare ID - Type Unspecified