Individual
CARA LYNN WALLACE-KOSMISKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS., CCC-SLP
Contact information
Practice address
1815 E HAMILTON ST, KIRKSVILLE, MO 63501-3903
(660) 665-5691
Mailing address
926 SHEPHARD BROTHERS BLVD, MOBERLY, MO 65270-3813
(660) 269-2600
(660) 269-2611
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
2012001027
MO
235Z00000X
Speech-Language Pathologist
Primary
2014006389
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14095942
ASHA
MO
05
—
1932462868
—
MO
01
—
2014006389
MISSOURI STATE BOARD OF REGISTRATION FOR HEALING ARTS SLP
MO
01
—
B-12 TEMPORARY AUTHO
MO DESE CERTIFICIATION
MO
Enumeration date
06/15/2012
Last updated
08/28/2024
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