Mary Colleen Kiesel
Individual provider Active NPI Speech-Language Pathologist · Dale, IN
NPI 1992040489 · NPPES record last updated Dec 10, 2012
Key facts
- NPI
- 1992040489
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 22002695A (IN)
- Practice address
- 404 W Willow Rd
Dale, IN 47523-8947 - Phone
- (812) 937-4489
- NPI assigned
- Dec 10, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22002695A | IN | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 22002695A | IN | Yes |
Addresses
Primary practice location
404 W Willow Rd
Dale, IN 47523-8947
Mailing address
404 W Willow Rd
Dale, IN 47523-8947
Phone (812) 937-4489
Other providers in Dale, IN
- Jayci Brenae Howe
- Ashraf Jewell
- Kimberly Renee Jochem
- Paula J Jochim
- Les John Kiesel
- Deborah Konerding
- Halle Marie Laswell
- Lifespring, Inc
- Lifespring, Inc
- Caymon Ariez Lowery
All providers in Dale, IN · Speech-Language Pathologist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.