Basic Information
| Provider Information | |||||||||
| NPI: | 1912197948 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLA DEITER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1711 N 4TH ST | ||||||||
| Address2: | |||||||||
| City: | ARKANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670051607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6204428700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7733 FORSYTH BLVD STE 1700 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631051801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006771238 | ||||||||
| FaxNumber: | 3148630769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2007 | ||||||||
| LastUpdateDate: | 07/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | DEITER | ||||||||
| AuthorizedOfficialFirstName: | CHARLA | ||||||||
| AuthorizedOfficialMiddleName: | KAY | ||||||||
| AuthorizedOfficialTitleorPosition: | SPEECH LANGUAGE PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 6204428700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.S. CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 2434 | KS | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.