Provider Demographics
NPI:1659409126
Name:RUBENACKER, KENNETH WAYNE (MS, CCC-A)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:WAYNE
Last Name:RUBENACKER
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 S KINGSHIGHWAY ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-2923
Mailing Address - Country:US
Mailing Address - Phone:573-471-7264
Mailing Address - Fax:573-471-7264
Practice Address - Street 1:417 SOUTH KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-2923
Practice Address - Country:US
Practice Address - Phone:573-471-7264
Practice Address - Fax:573-471-7264
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01570231H00000X
MO000803237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO45-00333OtherUNITED HEALTHCARE
MO121820OtherBLUE CROSS BLUE SHIELD
MO531661OtherHEALTHLINK