Provider Demographics
NPI:1154079374
Name:THEILEN, EMILY FAYE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:FAYE
Last Name:THEILEN
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 1:1200 N PERKINS RD APT G14
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-7132
Mailing Address - Country:US
Mailing Address - Phone:580-541-1227
Mailing Address - Fax:
Practice Address - Street 1:1200 N PERKINS RD APT G14
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-7132
Practice Address - Country:US
Practice Address - Phone:580-541-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist