Provider Demographics
NPI:1114584638
Name:STOLLER, THEA
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:
Last Name:STOLLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 BELLE GROVE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-7256
Mailing Address - Country:US
Mailing Address - Phone:804-878-9520
Mailing Address - Fax:
Practice Address - Street 1:2409 WEBBER AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-7713
Practice Address - Country:US
Practice Address - Phone:804-780-5008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist