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NPI Code Detail

MEDICARE: SARA JANE THEIN MA CCC-SLP

MEDICARE: SARA JANE THEIN MA CCC-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 Pathologist2004006674MO

General Provider Information

NPI Number : 1790514370
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA JANE THEIN MA CCC-SLP
Provider Business Mailing Address
First Line : 1028 COLUMBARD DR
Second Line :
City : BALLWIN
State : MO
Zip : 63021-7917
Country : US
Telephone Number : 314-623-5993
Fax Number :
Provider Business Practice Location Address
First Line : 1027 BELLEVUE AVE FL 3
Second Line :
City : RICHMOND HEIGHTS
State : MO
Zip : 63117-1996
Country : US
Telephone Number : 314-768-5336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2024
Last Update Date : 07/31/2024

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Directions to “ SARA JANE THEIN MA CCC-SLP” Practice Location

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