Individual
MAGEN MAE THIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
645 US HIGHWAY 12 SE, MONTROSE, MN 55363-8012
(218) 839-4106
Mailing address
645 US HIGHWAY 12 SE, MONTROSE, MN 55363-8012
(218) 839-4106
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
9986
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14315019
CAQH
—
05
—
SA2142
—
SC
Enumeration date
09/11/2017
Last updated
08/25/2022
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