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NPI Code Detail

MEDICARE: MRS. ANN MARIE THIESSEN SLP

MEDICARE: MRS. ANN MARIE THIESSEN SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist151NE

General Provider Information

NPI Number : 1134365760
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANN MARIE THIESSEN SLP
Provider Business Mailing Address
First Line : 803 S 218TH ST
Second Line :
City : ELKHORN
State : NE
Zip : 68022-1937
Country : US
Telephone Number : 402-690-5180
Fax Number :
Provider Business Practice Location Address
First Line : 1120 WALNUT ST
Second Line :
City : NORTH BEND
State : NE
Zip : 68649-5012
Country : US
Telephone Number : 402-652-3242
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2009
Last Update Date : 01/03/2009

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Directions to “ MRS. ANN MARIE THIESSEN SLP” Practice Location

Language Start Address Practice Location
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