Provider Demographics
NPI:1841446317
Name:KIESZ-ROYER, HOLLY MICHELLE (SLP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:MICHELLE
Last Name:KIESZ-ROYER
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 1:12500 SE RIDGECREST RD
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-6129
Mailing Address - Country:US
Mailing Address - Phone:503-762-2898
Mailing Address - Fax:
Practice Address - Street 1:12500 SE RIDGECREST RD
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-6129
Practice Address - Country:US
Practice Address - Phone:503-762-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11735235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist