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General NPI Number Information
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NPI Number | 1326593732
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Entity Type | Individual
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Provider Name | KELLY CIEZCZAK
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Gender | Female
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Dates
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Enumeration Date | 08/16/2016
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 966 CHEROKEE CT
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City | CROWN POINT
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State | IN
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Zip | 46307-4613
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Country | US
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Telephone | 219-671-0623
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Fax |
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Provider Business Mailing Address
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Address Line | 966 CHEROKEE CT
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City | CROWN POINT
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State | IN
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Zip | 46307-4613
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Country | US
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Telephone | 219-671-0623
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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 | 22006267A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 11718
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP-9837-SL
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License Number State | MA
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