Provider Demographics
NPI:1952737074
Name:ANDERSON, JOSEPH PAT
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PAT
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11568 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1865
Mailing Address - Country:US
Mailing Address - Phone:913-541-1818
Mailing Address - Fax:913-541-1899
Practice Address - Street 1:11568 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-1865
Practice Address - Country:US
Practice Address - Phone:913-541-1818
Practice Address - Fax:913-541-1899
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1523237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1523OtherHEARIG AID DISPENSER LICENSE