Provider Demographics
NPI:1851173488
Name:SLIEFF, POLLY ANN
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:ANN
Last Name:SLIEFF
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 1:1431 KINGSWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-9570
Mailing Address - Country:US
Mailing Address - Phone:270-990-1946
Mailing Address - Fax:
Practice Address - Street 1:308 ROSEDALE DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1530
Practice Address - Country:US
Practice Address - Phone:859-351-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1208738175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist