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General NPI Number Information
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NPI Number | 1164709747
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Entity Type | Individual
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Provider Name | KIMBERLY E DIONYSUS PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 2030 S NATIONAL AVE STE 105
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City | SPRINGFIELD
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State | MO
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Zip | 65804-2238
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Country | US
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Telephone | 417-820-9590
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Fax |
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Provider Business Mailing Address
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Address Line | 2030 S NATIONAL AVE STE 105
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City | SPRINGFIELD
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State | MO
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Zip | 65804-2238
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Country | US
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Telephone | 417-820-9590
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 071009108
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 2011037843
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License Number State | MO
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