Healthcare Provider Details

I. General information

NPI: 1407772924
Provider Name (Legal Business Name): MATTIE SUE THURMES M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 CHURCHILL ST W
STILLWATER MN
55082-6605
US

IV. Provider business mailing address

W5786 COUNTY ROAD V
BAY CITY WI
54723-8003
US

V. Phone/Fax

Practice location:
  • Phone: 651-439-5330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6866-154
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLICC-3180
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: