Provider Demographics
NPI:1679230700
Name:THIBODEAU, ANNIE THERESA
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:THERESA
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HEATHCLIFF WAY
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-8120
Mailing Address - Country:US
Mailing Address - Phone:978-758-5139
Mailing Address - Fax:
Practice Address - Street 1:17 HEATHCLIFF WAY
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-8120
Practice Address - Country:US
Practice Address - Phone:978-758-5139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist