Provider Demographics
NPI:1891091476
Name:SCHWAB, THYRA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:THYRA
Middle Name:
Last Name:SCHWAB
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 FOUNDERS CLUB DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-1440
Mailing Address - Country:US
Mailing Address - Phone:941-915-5099
Mailing Address - Fax:
Practice Address - Street 1:3414 FOUNDERS CLUB DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-1440
Practice Address - Country:US
Practice Address - Phone:941-915-5099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4731235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA4731OtherSTATE LICENSE NUMBER