Provider Demographics
NPI:1447916507
Name:KIESSER, ANNA (SLPA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KIESSER
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 HILLSTOCK CT
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-9236
Mailing Address - Country:US
Mailing Address - Phone:209-735-1846
Mailing Address - Fax:
Practice Address - Street 1:624 HILLSTOCK CT
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-9236
Practice Address - Country:US
Practice Address - Phone:209-735-1846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54332355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty