Provider Demographics
NPI:1699783779
Name:SOSTARICH, MARY E (AUD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:SOSTARICH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5809 SILVERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-8500
Mailing Address - Country:US
Mailing Address - Phone:630-352-8638
Mailing Address - Fax:
Practice Address - Street 1:1301 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3537
Practice Address - Country:US
Practice Address - Phone:630-352-8638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS640231H00000X
KS771237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100228600BMedicaid
KS014010003OtherMEDICARE PTAN
KS100228600BMedicaid