MEDICARE: ALEXA THIEL 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
1	235Z00000X	Speech-Language Pathologist	1851	NE

General Provider Information

NPI Number	:	1558744276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA THIEL SLP

Provider Business Mailing Address
First Line	:	503 KIMBERLY WAY
Second Line	:
City	:	SAINT LIBORY
State	:	NE
Zip	:	68872-9783
Country	:	US
Telephone Number	:	308-750-1601
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 KIMBERLY WAY
Second Line	:
City	:	SAINT LIBORY
State	:	NE
Zip	:	68872-9783
Country	:	US
Telephone Number	:	308-750-1601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	06/25/2021

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Directions to “ ALEXA THIEL SLP” Practice Location

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