Provider Demographics
NPI:1598078644
Name:NEUMANN, THEA (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:
Last Name:NEUMANN
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N12080 ALLISON LN
Mailing Address - Street 2:
Mailing Address - City:SILVER CLIFF
Mailing Address - State:WI
Mailing Address - Zip Code:54104-9411
Mailing Address - Country:US
Mailing Address - Phone:630-292-4104
Mailing Address - Fax:
Practice Address - Street 1:3117 SHORE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4293
Practice Address - Country:US
Practice Address - Phone:715-735-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3400-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist