Provider Demographics
NPI:1902070675
Name:THESSING, KATY J (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:J
Last Name:THESSING
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 1:2325 RAINBOW RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-2572
Mailing Address - Country:US
Mailing Address - Phone:501-514-3974
Mailing Address - Fax:
Practice Address - Street 1:2325 RAINBOW RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-2572
Practice Address - Country:US
Practice Address - Phone:501-514-3974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P7997235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist