1780959957 NPI number — MARY J. YANICS, PH.D., LLC

Table of content: (NPI 1780959957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780959957 NPI number — MARY J. YANICS, PH.D., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY J. YANICS, PH.D., LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780959957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8340 MISSION RD
Provider Second Line Business Mailing Address:
SUITE 228
Provider Business Mailing Address City Name:
PRAIRIE VILLAGE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66206-1355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-341-9444
Provider Business Mailing Address Fax Number:
913-341-9444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8340 MISSION RD
Provider Second Line Business Practice Location Address:
SUITE 228
Provider Business Practice Location Address City Name:
PRAIRIE VILLAGE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66206-1355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-341-9444
Provider Business Practice Location Address Fax Number:
913-341-9444
Provider Enumeration Date:
03/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
YANICS
Authorized Official First Name:
MARY
Authorized Official Middle Name:
JEANNE
Authorized Official Title or Position:
OWNER/SINGLE MEMBER
Authorized Official Telephone Number:
913-341-9444

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY 985 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 27632034 . This is a "BLUE CROSS/BLUE SHIELD OF KANSAS CITY" identifier . This identifiers is of the category "OTHER".




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