Provider Demographics
NPI:1124144837
Name:PARKS, JAIME L (MS CCC-A, AUD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:L
Last Name:PARKS
Suffix:
Gender:F
Credentials:MS CCC-A, AUD
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:L
Other - Last Name:WIGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4701 COLLEGE BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1934
Mailing Address - Country:US
Mailing Address - Phone:913-338-1200
Mailing Address - Fax:913-338-1205
Practice Address - Street 1:3655 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66206
Practice Address - Country:US
Practice Address - Phone:913-338-1200
Practice Address - Fax:913-338-1205
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2163237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2163OtherAUDIOLOGIST
KS2163OtherAUDIOLOGIST
KA3629001Medicare PIN