Provider Demographics
NPI:1285681247
Name:KYRIAKIDES, LEEANN RAE (MS CCC SLP, COM)
Entity Type:Individual
Prefix:MRS
First Name:LEEANN
Middle Name:RAE
Last Name:KYRIAKIDES
Suffix:
Gender:F
Credentials:MS CCC SLP, COM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7231 FORESTVIEW LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-5501
Mailing Address - Country:US
Mailing Address - Phone:763-315-6616
Mailing Address - Fax:
Practice Address - Street 1:7231 FORESTVIEW LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5536
Practice Address - Country:US
Practice Address - Phone:763-315-6166
Practice Address - Fax:763-315-8894
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7514235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist