Provider Demographics
NPI:1467545145
Name:THIEL, JESSICA JO (MA, CCC-SLP; MHSA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JO
Last Name:THIEL
Suffix:
Gender:F
Credentials:MA, CCC-SLP; MHSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43571-9623
Mailing Address - Country:US
Mailing Address - Phone:602-499-0305
Mailing Address - Fax:
Practice Address - Street 1:6625 NORTH ST
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:OH
Practice Address - Zip Code:43571-9623
Practice Address - Country:US
Practice Address - Phone:602-499-0305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.09323235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist