Provider Demographics
NPI:1639052467
Name:THOELE, KATHLEEN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:THOELE
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 1:2605 ENFIELD RD APT 223
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-3767
Mailing Address - Country:US
Mailing Address - Phone:972-839-2824
Mailing Address - Fax:512-991-9753
Practice Address - Street 1:1715 S CAPITAL OF TEXAS HWY STE 208
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6561
Practice Address - Country:US
Practice Address - Phone:512-845-6567
Practice Address - Fax:512-991-9753
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122693235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty