Provider Demographics
NPI:1831249259
Name:KYRAMARIOS, DESPINA (PENNY) ANGELA (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DESPINA (PENNY)
Middle Name:ANGELA
Last Name:KYRAMARIOS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 CLAYTONBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-1586
Mailing Address - Country:US
Mailing Address - Phone:636-256-2467
Mailing Address - Fax:
Practice Address - Street 1:4810 MEADOWS PKWY
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-2227
Practice Address - Country:US
Practice Address - Phone:636-851-6016
Practice Address - Fax:636-851-6198
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0336340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist