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General NPI Number Information
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NPI Number | 1912147877
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Entity Type | Individual
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Provider Name | MRS. JODY ANN DANILIUK THIEMAN
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Gender | Female
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 03/04/2009
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Provider Practice Location Address
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Address Line | 821 STUART CIR
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City | FRANKFORT
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State | IL
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Zip | 60423-9783
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Country | US
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Telephone | 815-464-8265
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Fax |
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Provider Business Mailing Address
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Address Line | 821 STUART CIRCLE
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City | FRANKFORT
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State | IL
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Zip | 60423
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Country | US
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Telephone | 815-464-8265
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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 | 146-005275
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License Number State | IL
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