Provider Demographics
NPI:1124560503
Name:KIESGEN, LINDSEY (AUD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:KIESGEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 VILLAGE CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9044
Mailing Address - Country:US
Mailing Address - Phone:770-507-0384
Mailing Address - Fax:
Practice Address - Street 1:214 VILLAGE CENTER PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9044
Practice Address - Country:US
Practice Address - Phone:770-507-0384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
AUD004278231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician