Individual
DONNA THIELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP-A
Contact information
Practice address
74 ROCK RIDGE RUN, KIMBERLY A. EGBERTS & ASSOC, CUMBERLAND CENTER, ME 04021
(207) 829-4763
(207) 829-4763
Mailing address
14 EMERY STRREET, LISBON, ME 04250
(207) 353-9009
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
SAS1719
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432814800
—
ME
Enumeration date
11/06/2009
Last updated
11/06/2009
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