Individual
KATHLEEN STACIE THEILACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
9280 SE SUNNYBROOK BLVD STE 300, CLACKAMAS, OR 97015-9353
(503) 233-5548
(503) 230-1009
Mailing address
9280 SE SUNNYBROOK BLVD STE 300, CLACKAMAS, OR 97015-9353
(503) 233-5548
(503) 230-1009
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
31052
OR
2355S0801X
Speech-Language Assistant
4382
CA
Other
Enumeration date
11/01/2017
Last updated
09/14/2022
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