Provider Demographics
NPI:1629583760
Name:MITTLER, THOMAS SR
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MITTLER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 WILDSPRING PKWY
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8897
Mailing Address - Country:US
Mailing Address - Phone:815-439-7092
Mailing Address - Fax:815-577-9476
Practice Address - Street 1:2001 WILDSPRING PKWY
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8897
Practice Address - Country:US
Practice Address - Phone:815-439-7092
Practice Address - Fax:815-577-9476
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.002940235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist