Healthcare Provider Details

I. General information

NPI: 1861058034
Provider Name (Legal Business Name): KALENE NICOLE SIECKMANN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 SAN FERNANDO LN
EAST AMHERST NY
14051-2234
US

IV. Provider business mailing address

128 BARNSDALE AVE
WEST SENECA NY
14224-1104
US

V. Phone/Fax

Practice location:
  • Phone: 716-689-2916
  • Fax:
Mailing address:
  • Phone: 716-499-5930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: