Provider Demographics
NPI:1629689633
Name:KIRK, VERONICA LYNN
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:LYNN
Last Name:KIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 ORLEANS LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-2114
Mailing Address - Country:US
Mailing Address - Phone:314-600-3896
Mailing Address - Fax:
Practice Address - Street 1:2270 ORLEANS LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-2114
Practice Address - Country:US
Practice Address - Phone:314-600-3896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician