Provider Demographics
NPI:1053690602
Name:KIEFL, LINDSEY MARIE (AUD)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MARIE
Last Name:KIEFL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 EAST GENESEE STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1505
Mailing Address - Country:US
Mailing Address - Phone:315-476-3127
Mailing Address - Fax:315-476-3136
Practice Address - Street 1:721 EAST GENESEE STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1505
Practice Address - Country:US
Practice Address - Phone:315-476-3127
Practice Address - Fax:315-476-3136
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002362231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400054426Medicare UPIN