Healthcare Provider Details

I. General information

NPI: 1255779336
Provider Name (Legal Business Name): KRISTEN MARIE LYREK M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN MARIE ANDREW M.A. CCC-SLP

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 LINCOLN AVE
SAINT PAUL MN
55105-3149
US

IV. Provider business mailing address

957 LINCOLN AVE
SAINT PAUL MN
55105-3149
US

V. Phone/Fax

Practice location:
  • Phone: 918-706-8242
  • Fax:
Mailing address:
  • Phone: 918-706-8242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9104
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: