Provider Demographics
NPI:1073830329
Name:SIEHL, GEORGIANA PACINI (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:GEORGIANA
Middle Name:PACINI
Last Name:SIEHL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5802
Mailing Address - Country:US
Mailing Address - Phone:734-747-7717
Mailing Address - Fax:734-747-7711
Practice Address - Street 1:1325 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5802
Practice Address - Country:US
Practice Address - Phone:734-747-7717
Practice Address - Fax:734-747-7711
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00264572235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI00264572OtherASHA