Provider Demographics
NPI:1740489616
Name:THIGPEN-WYATT, SHARRITHA LYNISE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHARRITHA
Middle Name:LYNISE
Last Name:THIGPEN-WYATT
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 1:410 W TOWNSHIP LINE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5237
Mailing Address - Country:US
Mailing Address - Phone:484-466-1254
Mailing Address - Fax:
Practice Address - Street 1:410 W TOWNSHIP LINE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5237
Practice Address - Country:US
Practice Address - Phone:484-466-1254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist