Provider Demographics
NPI:1053388660
Name:RUDER, LAWRENCE L (MA CCCA)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:L
Last Name:RUDER
Suffix:
Gender:M
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 MISSION RD STE 146
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3005
Mailing Address - Country:US
Mailing Address - Phone:913-384-2105
Mailing Address - Fax:913-384-0735
Practice Address - Street 1:12330 METCALF AVE
Practice Address - Street 2:SUITE 560
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1324
Practice Address - Country:US
Practice Address - Phone:913-498-2827
Practice Address - Fax:913-498-1052
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS867231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100398800AMedicaid
14105034OtherBCBS OF KANSAS CITY
640004509OtherTRAVELERS MEDICARE
481106646OtherHUMANA
7184252OtherAETNA
KSLE714OtherHEARING AID DISPENSING LI
P33678OtherCOVENTRY
D224647Medicare ID - Type Unspecified
P33678Medicare UPIN