Individual
PATRICIA SELF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD-CCC, SLP
Contact information
Practice address
5015 E 29TH ST N, ENTRANCE 'T', WICHITA, KS 67220-2110
(316) 978-3289
(316) 978-7264
Mailing address
1845 FAIRMOUNT ST, WICHITA, KS 67260-0099
(316) 978-3289
(316) 978-7264
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
861
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11397
PHS
KS
01
—
115025
BLUE CROSS BLUE SHIELD
KS
Enumeration date
06/12/2007
Last updated
07/08/2007
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