Individual
TANNER JORDAN STAAB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3636 N RIDGE RD, WICHITA, KS 67205-1213
(316) 462-3636
Mailing address
4060 N REED AVE APT 912, MAIZE, KS 67101-3813
(785) 259-1516
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3572
KS
Other
Enumeration date
06/02/2020
Last updated
06/18/2020
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