Healthcare Provider Details

I. General information

NPI: 1578470688
Provider Name (Legal Business Name): KYRSTEN CARMOSINO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 VICTORY LN
LIBERTY MO
64068-1920
US

IV. Provider business mailing address

10124 W 59TH TER
SHAWNEE KS
66203-3042
US

V. Phone/Fax

Practice location:
  • Phone: 816-736-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2022032438
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: