Healthcare Provider Details

I. General information

NPI: 1942413133
Provider Name (Legal Business Name): JENNIFER ERIN KIERSZ M.ED. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5008 CASCADE POOLS AVE
LAS VEGAS NV
89131-3626
US

IV. Provider business mailing address

8204 NEW LEAF AVE
LAS VEGAS NV
89131-8186
US

V. Phone/Fax

Practice location:
  • Phone: 702-203-7504
  • Fax:
Mailing address:
  • Phone: 919-602-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-911
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: