Individual
JESSICA KIRYANOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
L644204
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073658597
—
MI
Enumeration date
07/29/2015
Last updated
08/05/2025
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