Healthcare Provider Details

I. General information

NPI: 1467545145
Provider Name (Legal Business Name): JESSICA JO THIEL M.A., CCC-SLP; MHSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 NORTH ST
WHITEHOUSE OH
43571-9623
US

IV. Provider business mailing address

6625 NORTH ST
WHITEHOUSE OH
43571-9623
US

V. Phone/Fax

Practice location:
  • Phone: 602-499-0305
  • Fax:
Mailing address:
  • Phone: 602-499-0305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.09323
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: