Provider Demographics
NPI:1104714310
Name:KIESER, LANCE DAVID (AUD)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:DAVID
Last Name:KIESER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9860 E TAMERY AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-1204
Mailing Address - Country:US
Mailing Address - Phone:309-231-4358
Mailing Address - Fax:
Practice Address - Street 1:2045 S VINEYARD STE 139
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6891
Practice Address - Country:US
Practice Address - Phone:480-770-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA16222231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty