Provider Demographics
NPI:1144279266
Name:KAMPE, STACEY DAWN (AUD CCC A)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:DAWN
Last Name:KAMPE
Suffix:
Gender:F
Credentials:AUD CCC A
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:DAWN
Other - Last Name:DICKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1845 FAIRMOUNT ST
Mailing Address - Street 2:CAMPUS BOX 99
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67260-0099
Mailing Address - Country:US
Mailing Address - Phone:316-978-3289
Mailing Address - Fax:316-978-7264
Practice Address - Street 1:5015 E 29TH ST N
Practice Address - Street 2:DOOR T
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2110
Practice Address - Country:US
Practice Address - Phone:316-978-3289
Practice Address - Fax:316-978-7264
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA00921231H00000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS640002456OtherRAIL ROAD MEDICARE
KS100228550AMedicaid
KS100228550AMedicaid