Provider Demographics
NPI:1750024436
Name:KIESLING, ALEXA LEE
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:LEE
Last Name:KIESLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-2225
Mailing Address - Country:US
Mailing Address - Phone:631-413-6678
Mailing Address - Fax:
Practice Address - Street 1:170 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-2225
Practice Address - Country:US
Practice Address - Phone:631-413-6678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist