Alison Brooke Theobald, CCC-SLP
Speech-Language Pathologist, in Jackson, MO. Individual provider (NPI-1).
NPI number1194331504
StatusActive
Last updated in NPPESOct 22, 2021
Details
- NPI
- 1194331504
- Entity type
- Individual (NPI-1)
- Name
- Alison Brooke Theobald
- Credential
- CCC-SLP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 21, 2020
- Certification date
- Oct 22, 2021
- Last updated
- Oct 22, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 235Z00000X | Speech-Language Pathologist, | 2020029626 | MO | Yes |
Practice location
614 E Adams StJackson, MO 63755-2150
Phone 573-243-9513
Mailing address
12110 Clayton RdSaint Louis, MO 63131-2516
Phone 314-989-8150
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