Provider Demographics
NPI:1437676814
Name:KIRSCH, THERESA ANN (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANN
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-9029
Mailing Address - Country:US
Mailing Address - Phone:937-497-2200
Mailing Address - Fax:937-497-2211
Practice Address - Street 1:1250 PARK ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-1143
Practice Address - Country:US
Practice Address - Phone:937-497-2264
Practice Address - Fax:937-497-2263
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCI1016377235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist