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

Table of Contents

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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