Provider Demographics
NPI:1861058034
Name:SIECKMANN, KALENE NICOLE (SLP)
Entity type:Individual
Prefix:
First Name:KALENE
Middle Name:NICOLE
Last Name:SIECKMANN
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 1:128 BARNSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1104
Mailing Address - Country:US
Mailing Address - Phone:716-499-5930
Mailing Address - Fax:
Practice Address - Street 1:26 SAN FERNANDO LN
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2234
Practice Address - Country:US
Practice Address - Phone:716-689-2916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist