Healthcare Provider Details

I. General information

NPI: 1831249259
Provider Name (Legal Business Name): DESPINA (PENNY) ANGELA KYRAMARIOS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 MEADOWS PKWY
WELDON SPRING MO
63304-2227
US

IV. Provider business mailing address

1003 CLAYTONBROOK DR
BALLWIN MO
63011-1586
US

V. Phone/Fax

Practice location:
  • Phone: 636-851-6016
  • Fax: 636-851-6198
Mailing address:
  • Phone: 636-256-2467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0336340
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: