Organization
KANSAS COGNITIVE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JESSICA R TEBOW (PRACTICE MANAGER)
(316) 358-7257
Entity
Organization
Contact information
Practice address
250 N ROCK RD STE 170, WICHITA, KS 67206-2287
(316) 358-7257
(316) 358-7002
Mailing address
250 N ROCK RD STE 170, WICHITA, KS 67206-2287
(316) 358-7257
(316) 358-7002
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
KA4607
—
KS
Enumeration date
04/28/2021
Last updated
04/28/2021
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