Provider Demographics
NPI:1891926150
Name:THEIL, CAROL (SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:THEIL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11635 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-4319
Mailing Address - Country:US
Mailing Address - Phone:216-231-8787
Mailing Address - Fax:216-231-7141
Practice Address - Street 1:11635 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4319
Practice Address - Country:US
Practice Address - Phone:216-231-8787
Practice Address - Fax:216-231-7141
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-2318235Z00000X
OHSP.02318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1564187Medicaid
OH1564187Medicaid