| NPI | 1255831525 |
|---|---|
| Former Name | KELLSIE DIESER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: IA 096458) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: SD 470-A) |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2019-05-03 |