Provider Demographics
NPI:1205006046
Name:THIELE, NATALIE JOANNE (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:JOANNE
Last Name:THIELE
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15825 MANCHESTER RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2263
Mailing Address - Country:US
Mailing Address - Phone:636-391-9622
Mailing Address - Fax:636-391-9236
Practice Address - Street 1:10094 LITZSINGER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1132
Practice Address - Country:US
Practice Address - Phone:636-391-9622
Practice Address - Fax:636-391-9236
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01909231H00000X
MO000810237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist