Individual
MRS. CARISSA LYNN THIELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
390 E CONGRESS PKWY, SUITE A, CRYSTAL LAKE, IL 60014-6202
(815) 477-4788
(815) 477-4790
Mailing address
390 E CONGRESS PKWY, SUITE A, CRYSTAL LAKE, IL 60014-6202
(815) 477-4788
(815) 477-4790
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146010746
IL
Other
Enumeration date
06/03/2013
Last updated
06/03/2013
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