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Individual

KIMBERLY E DIONYSUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PSYD

Contact information

Practice address
2030 S NATIONAL AVE STE 105, SPRINGFIELD, MO 65804-2238
(417) 820-9590
Mailing address
2030 S NATIONAL AVE STE 105, SPRINGFIELD, MO 65804-2238
(417) 820-9590

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
071009108
IL
103G00000X
Clinical Neuropsychologist
Primary
2011037843
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1164709747
MP
05
200437390A
OK
05
200750120A
KS
Enumeration date
11/09/2011
Last updated
07/09/2020
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