Provider Demographics
NPI:1932146727
Name:SCIESZKA, KATHY
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:SCIESZKA
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 1:5000 CHESHIRE PKWY N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-4103
Mailing Address - Country:US
Mailing Address - Phone:888-510-0766
Mailing Address - Fax:763-268-4017
Practice Address - Street 1:3945 OKEMOS RD
Practice Address - Street 2:B1
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-4207
Practice Address - Country:US
Practice Address - Phone:517-349-0200
Practice Address - Fax:517-349-3030
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000450231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM38010017Medicare ID - Type UnspecifiedIND PROV ID NUMBER
MIM03110031Medicare PIN