Individual
MRS. KELLY AMBER WUSTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
10300 W 103RD ST, SUITE 300, OVERLAND PARK, KS 66214-2642
(913) 891-1910
Mailing address
5305 NW HANOVER CT, BLUE SPRINGS, MO 64015-2320
(816) 220-2850
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12095223
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12095223
NATIONAL CERTIFICATION
—
01
—
2005037012
STATE LICENSE
MO
01
—
2557
STATE LICENSE
KS
Enumeration date
02/20/2007
Last updated
07/08/2007
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