Provider Demographics
NPI:1619373602
Name:KIEFER, REGINA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:KIEFER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 CLIMBING FIG DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-7161
Mailing Address - Country:US
Mailing Address - Phone:614-864-9089
Mailing Address - Fax:
Practice Address - Street 1:55 HIGH ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:OH
Practice Address - Zip Code:43112-9018
Practice Address - Country:US
Practice Address - Phone:740-639-4218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP0510235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist