Individual
RYAN WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
872 S 291 HWY, LIBERTY, MO 64068-2296
(816) 415-1700
(816) 415-1705
Mailing address
872 S 291 HWY, LIBERTY, MO 64068-2296
(816) 415-1700
(816) 415-1705
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
2013007124
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2013007124
HEARING AID DISPENSER LICENSE
MO
Enumeration date
09/20/2013
Last updated
09/20/2013
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