1669269254 NPI number — KALEIDOSCOPE SPEECH-LANGUAGE THERAPY LLC

Table of content: (NPI 1669269254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669269254 NPI number — KALEIDOSCOPE SPEECH-LANGUAGE THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KALEIDOSCOPE SPEECH-LANGUAGE THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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NPI Number Information

NPI Number:
1669269254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
818 W SLATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDOVER
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67002-7511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-518-1325
Provider Business Mailing Address Fax Number:
316-518-1325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1951 N ANDOVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDOVER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67002-9465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-247-0137
Provider Business Practice Location Address Fax Number:
855-761-1356
Provider Enumeration Date:
04/24/2025

Additional Information

Authorized Official

Authorized Official Last Name:
FLANAGAN
Authorized Official First Name:
STACI
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
316-518-1325

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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