Individual
ANNELISE THIFAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2525 OHIO PKWY, ROCKFORD, IL 61108-7517
(815) 229-2800
Mailing address
273 CORDIAL DR, BRIDGEVILLE, PA 15017-1133
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
242.004652
IL
Other
Enumeration date
11/15/2017
Last updated
11/15/2017
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