Individual
MS. MARY BETH THIELE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
1235 S 24TH ST, MANITOWOC, WI 54220-5516
(920) 682-8254
Mailing address
1530 S 30TH ST APT 8, MANITOWOC, WI 54220-5955
(920) 207-0333
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2876-154
WI
Other
Enumeration date
06/07/2007
Last updated
07/08/2007
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