| NPI | 1205068681 |
|---|---|
| Former Name | CRYSTAL LEE KIECKHOEFER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MN 8889) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WI 3282-154) |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2017-01-12 |