Provider Demographics
NPI:1265870398
Name:STUCHLIK, TINA R (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:R
Last Name:STUCHLIK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:EWY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFY-SLP
Mailing Address - Street 1:8700 E 29TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2169
Mailing Address - Country:US
Mailing Address - Phone:316-634-8710
Mailing Address - Fax:316-634-8891
Practice Address - Street 1:3223 N OLIVER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2106
Practice Address - Country:US
Practice Address - Phone:316-267-5437
Practice Address - Fax:316-267-5444
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2928235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist