Individual
KATLYN RENE NIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
109 AUBURN AVE, SHELBY, OH 44875-1103
(419) 342-5456
Mailing address
5786 GWIRTZ RD, SHELBY, OH 44875-9405
(419) 543-1018
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
COND20191193SP
OH
235Z00000X
Speech-Language Pathologist
Primary
SP.14086
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0414168
—
OH
Enumeration date
02/17/2020
Last updated
04/23/2022
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