Provider Demographics
NPI:1528272424
Name:CONSTANCE, JANE E (SLP, MA CCC)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:E
Last Name:CONSTANCE
Suffix:
Gender:F
Credentials:SLP, MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7803 SW CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-8145
Mailing Address - Country:US
Mailing Address - Phone:316-775-1181
Mailing Address - Fax:
Practice Address - Street 1:7803 SW CEDAR LN
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-8145
Practice Address - Country:US
Practice Address - Phone:316-775-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2339OtherPHS
KS0000018341OtherBLUECROSS BLUESHIELD
KS0000018341OtherBLUECROSS BLUESHIELD