Provider Demographics
NPI:1699234062
Name:THYER, ALLIE E (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:E
Last Name:THYER
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 1:716 W WARREN ST
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62014-1012
Mailing Address - Country:US
Mailing Address - Phone:618-550-0451
Mailing Address - Fax:
Practice Address - Street 1:6301 HUMBERT RD
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-2163
Practice Address - Country:US
Practice Address - Phone:618-466-0367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010664235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist