Provider Demographics
NPI:1306125489
Name:KYRIAS, CARRIE A (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:KYRIAS
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 1:411 DEINHARD LN STE F208
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-4800
Mailing Address - Country:US
Mailing Address - Phone:208-572-9040
Mailing Address - Fax:208-576-6941
Practice Address - Street 1:303 MATHER RD
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-4800
Practice Address - Country:US
Practice Address - Phone:208-572-9040
Practice Address - Fax:208-576-6941
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-2298235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist