Provider Demographics
NPI:1841554128
Name:SIEKLUCKI, KARA STEPHANIE (MS EDUCATION)
Entity type:Individual
Prefix:MRS
First Name:KARA
Middle Name:STEPHANIE
Last Name:SIEKLUCKI
Suffix:
Gender:F
Credentials:MS EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MEROKE LN
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-3313
Mailing Address - Country:US
Mailing Address - Phone:631-650-7451
Mailing Address - Fax:
Practice Address - Street 1:124 MEROKE LN
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-3313
Practice Address - Country:US
Practice Address - Phone:631-650-7451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-01
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720325961174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist