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General NPI Number Information
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NPI Number | 1245567544
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Entity Type | Individual
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Provider Name | DONNA THIELE SLP-A
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Gender | Female
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 11/06/2009
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Provider Practice Location Address
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Address Line | 74 ROCK RIDGE RUN KIMBERLY A. EGBERTS & ASSOC
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City | CUMBERLAND CENTER
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State | ME
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Zip | 04021
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Country | US
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Telephone | 207-829-4763
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Fax | 207-829-4763
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Provider Business Mailing Address
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Address Line | 14 EMERY STRREET
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City | LISBON
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State | ME
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Zip | 04250
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Country | US
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Telephone | 207-353-9009
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SAS1719
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License Number State | ME
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