Basic Information
| Provider Information | |||||||||
| NPI: | 1659661817 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIRKS | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 613 E ACORN ST | ||||||||
| Address2: | |||||||||
| City: | GARDNER | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660308113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134065348 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5211 W 103RD ST | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662073154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133832569 | ||||||||
| FaxNumber: | 9133832611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2011 | ||||||||
| LastUpdateDate: | 04/08/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2567 | KS | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.