Individual
MARY COLLEEN KIESEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
404 W WILLOW RD, DALE, IN 47523-8947
(812) 937-4489
Mailing address
404 W WILLOW RD, DALE, IN 47523-8947
(812) 937-4489
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22002695A
IN
Other
Enumeration date
12/10/2012
Last updated
12/10/2012
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