Provider Demographics
NPI:1346397809
Name:KIERSH, NANCY ETTA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ETTA
Last Name:KIERSH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4033
Mailing Address - Country:US
Mailing Address - Phone:203-226-5671
Mailing Address - Fax:
Practice Address - Street 1:121 BAYBERRY LN
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4033
Practice Address - Country:US
Practice Address - Phone:203-226-5671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist