Provider Demographics
NPI:1740635457
Name:SIEFKER, LILA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LILA
Middle Name:
Last Name:SIEFKER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 MEDINAH WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4411
Mailing Address - Country:US
Mailing Address - Phone:407-902-7277
Mailing Address - Fax:
Practice Address - Street 1:5811 MEDINAH WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4411
Practice Address - Country:US
Practice Address - Phone:407-902-7277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-01
Last Update Date:2016-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist