Active NPI
Tanner Jordan Staab
- Speech-Language Pathologist
- Wichita, KS
National Provider Identifier
1477177863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 3572
- Practice address
- 3636 N Ridge Rd
Wichita, KS 67205-1213 - Phone
- (316) 462-3636
- NPI assigned
- Jun 2, 2020
- Last updated
- Jun 18, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 3572 | KS | Primary |
Addresses
Primary practice location
3636 N Ridge Rd
Wichita, KS 67205-1213
Mailing address
4060 N Reed Ave Apt 912
Maize, KS 67101-3813
Phone (785) 259-1516
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3572 | KS | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592438400000",
"number": "1477177863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4060 N REED AVE APT 912",
"city": "MAIZE",
"state": "KS",
"postal_code": "671013813",
"telephone_number": "785-259-1516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3636 N RIDGE RD",
"city": "WICHITA",
"state": "KS",
"postal_code": "672051213",
"telephone_number": "316-462-3636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAAB",
"first_name": "TANNER",
"middle_name": "JORDAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-02",
"last_updated": "2020-06-18",
"certification_date": "2020-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "KS",
"license": "3572",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.