Provider Demographics
NPI:1932878964
Name:CUNDIFF, KARA LEANN
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:LEANN
Last Name:CUNDIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 CHERIE CT
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-5211
Mailing Address - Country:US
Mailing Address - Phone:816-589-8356
Mailing Address - Fax:
Practice Address - Street 1:1201 COPPER RIDGE CT APT 201
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-5004
Practice Address - Country:US
Practice Address - Phone:816-589-8356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021025558235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist