Provider Demographics
NPI:1780841379
Name:VERNON, KRISJEANA M (MS)
Entity Type:Individual
Prefix:
First Name:KRISJEANA
Middle Name:M
Last Name:VERNON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KRISJEANA
Other - Middle Name:M
Other - Last Name:BALLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:4790 EXECUTIVE CENTRE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ST. PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376
Mailing Address - Country:US
Mailing Address - Phone:636-441-3100
Mailing Address - Fax:636-926-8519
Practice Address - Street 1:4790 EXECUTIVE CENTRE PARKWAY
Practice Address - Street 2:
Practice Address - City:ST. PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:636-441-3100
Practice Address - Fax:636-926-8519
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007007757231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist