Healthcare Provider Details

I. General information

NPI: 1235046327
Provider Name (Legal Business Name): MARY BETH THEYERL MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4031 KENNETT PIKE
WILMINGTON DE
19807-2047
US

IV. Provider business mailing address

1807 N MONROE ST
WILMINGTON DE
19802-3919
US

V. Phone/Fax

Practice location:
  • Phone: 302-658-6200
  • Fax:
Mailing address:
  • Phone: 302-893-3686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number01-0000706
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: