Provider Demographics
NPI:1609166636
Name:KIEDINGER, SARA LOUISE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LOUISE
Last Name:KIEDINGER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 N ORANGE AVE
Mailing Address - Street 2:2201
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1378
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:668 N ORANGE AVE
Practice Address - Street 2:2201
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1378
Practice Address - Country:US
Practice Address - Phone:321-303-8603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist