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General NPI Number Information
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NPI Number | 1629583760
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Entity Type | Individual
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Provider Name | THOMAS MITTLER SR.
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Gender | Male
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 12/12/2017
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Provider Practice Location Address
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Address Line | 2001 WILDSPRING PKWY
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City | JOLIET
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State | IL
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Zip | 60431-8897
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Country | US
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Telephone | 815-439-7092
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Fax | 815-577-9476
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Provider Business Mailing Address
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Address Line | 2001 WILDSPRING PKWY
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City | JOLIET
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State | IL
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Zip | 60431-8897
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Country | US
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Telephone | 815-439-7092
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Fax | 815-577-9476
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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 | 146.002940
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License Number State | IL
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