Provider Demographics
NPI:1558744276
Name:THIEL, ALEXA (SLP)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:THIEL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:
Other - Last Name:LEWANDOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:503 KIMBERLY WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT LIBORY
Mailing Address - State:NE
Mailing Address - Zip Code:68872-9783
Mailing Address - Country:US
Mailing Address - Phone:308-750-1601
Mailing Address - Fax:
Practice Address - Street 1:503 KIMBERLY WAY
Practice Address - Street 2:
Practice Address - City:SAINT LIBORY
Practice Address - State:NE
Practice Address - Zip Code:68872-9783
Practice Address - Country:US
Practice Address - Phone:308-750-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1851235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist