Provider Demographics
NPI:1497222483
Name:KIEHL, JON M (HIS)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:M
Last Name:KIEHL
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 TOWER AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-5388
Mailing Address - Country:US
Mailing Address - Phone:715-718-4112
Mailing Address - Fax:
Practice Address - Street 1:3215 TOWER AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5388
Practice Address - Country:US
Practice Address - Phone:715-718-4112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-28
Last Update Date:2018-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist