Provider Demographics
NPI:1972392694
Name:NIESE, NATASHA
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:NIESE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3791 ROAD 12
Mailing Address - Street 2:
Mailing Address - City:LEIPSIC
Mailing Address - State:OH
Mailing Address - Zip Code:45856-8913
Mailing Address - Country:US
Mailing Address - Phone:419-235-0743
Mailing Address - Fax:
Practice Address - Street 1:4 OLIVER CT # 105
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8708
Practice Address - Country:US
Practice Address - Phone:843-706-9367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist