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General NPI Number Information
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NPI Number | 1104060060
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Entity Type | Individual
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Provider Name | MIEKKA ESTELLE THYE M.S., CCC/SLP
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Gender | Female
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 4830 SOUTH FWY
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City | FORT WORTH
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State | TX
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Zip | 76115-3901
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Country | US
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Telephone | 817-926-3330
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Fax | 817-926-5303
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Provider Business Mailing Address
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Address Line | 3305 HAZLEWOOD CT
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City | BEDFORD
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State | TX
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Zip | 76021-2957
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Country | US
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Telephone | 817-308-9058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 16001
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License Number State | TX
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