Provider Demographics
NPI:1396470498
Name:THATCHER, CHRISTY JOAN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:JOAN
Last Name:THATCHER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TURRET DR
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468-4317
Mailing Address - Country:US
Mailing Address - Phone:610-304-6387
Mailing Address - Fax:
Practice Address - Street 1:1 TURRET DR
Practice Address - Street 2:
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-4317
Practice Address - Country:US
Practice Address - Phone:610-304-6387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61017780235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL006456LMedicaid
WALL61017780Medicaid