Provider Demographics
NPI:1639354574
Name:THAYER, ERIN E
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:E
Last Name:THAYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:E
Other - Last Name:TRYGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:10155 TENNYSON DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3647
Mailing Address - Country:US
Mailing Address - Phone:248-252-6064
Mailing Address - Fax:
Practice Address - Street 1:10155 TENNYSON DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-3647
Practice Address - Country:US
Practice Address - Phone:248-252-6064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
MI7101002897235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No251C00000XAgenciesDay Training, Developmentally Disabled Services