Provider Demographics
NPI:1154890390
Name:THALER, THERESA KATHARINE
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:KATHARINE
Last Name:THALER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8247 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-5505
Mailing Address - Country:US
Mailing Address - Phone:410-465-6550
Mailing Address - Fax:
Practice Address - Street 1:10320 QUARTERSTAFF RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4138
Practice Address - Country:US
Practice Address - Phone:401-313-6866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist