Provider Demographics
NPI:1770367088
Name:THAYER, ARIEL ROSE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ARIEL
Middle Name:ROSE
Last Name:THAYER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:ARIEL
Other - Middle Name:ROSE
Other - Last Name:SCHUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:593 SOMERVILLE AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3274
Mailing Address - Country:US
Mailing Address - Phone:215-206-6566
Mailing Address - Fax:
Practice Address - Street 1:593 SOMERVILLE AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-3274
Practice Address - Country:US
Practice Address - Phone:215-206-6566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31963235Z00000X
NY1701388235Z00000X
MA76882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist