Provider Demographics
NPI:1902388481
Name:KIRIAKOS, GEORGIA ANASTASIA
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:ANASTASIA
Last Name:KIRIAKOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9733 BELL ROCK RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-9207
Mailing Address - Country:US
Mailing Address - Phone:972-415-6026
Mailing Address - Fax:
Practice Address - Street 1:12400 DALLAS PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4224
Practice Address - Country:US
Practice Address - Phone:877-847-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103587235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist