Provider Demographics
NPI:1255461232
Name:KELLY SIEG INCORPORATED
Entity type:Organization
Organization Name:KELLY SIEG INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SIEG
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC,SLP, BCBA
Authorized Official - Phone:352-746-9233
Mailing Address - Street 1:1651 W GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-7722
Mailing Address - Country:US
Mailing Address - Phone:352-746-9233
Mailing Address - Fax:352-746-9323
Practice Address - Street 1:1651 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-7722
Practice Address - Country:US
Practice Address - Phone:352-746-9233
Practice Address - Fax:352-746-9323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5678235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty