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General NPI Number Information
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NPI Number | 1134633415
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Entity Type | Individual
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Provider Name | MRS. DARLA MAE KIESER
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Gender | Female
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Dates
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Enumeration Date | 11/26/2017
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Last Update Date | 01/01/2018
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Provider Practice Location Address
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Address Line | 1031 5TH AVE
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City | BELVIDERE
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State | IL
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Zip | 61008-5139
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Country | US
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Telephone | 815-262-1559
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Fax |
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Provider Business Mailing Address
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Address Line | 8693 CENTAUR DR
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City | BELVIDERE
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State | IL
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Zip | 61008-8721
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Country | US
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Telephone | 815-262-1559
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146.002304
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License Number State | IL
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