Thea Sue Cornwell, MA, CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Monona, WI
NPI 1508599358 · NPPES record last updated Dec 13, 2024
Key facts
- NPI
- 1508599358
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 6199 (WI)
- Practice address
- 1050 E Broadway
Monona, WI 53716-4023 - Phone
- (608) 890-6110
- NPI assigned
- Jul 7, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6199 | WI | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 6199 | WI | Yes |
| Speech-Language Pathologist | 235Z00000X | 528308 | MN |
Addresses
Primary practice location
1050 E Broadway
Monona, WI 53716-4023
Mailing address
1050 E Broadway
Monona, WI 53716-4023
Phone (608) 890-6110
Other providers in Monona, WI
- Aven Comstock
- Dayna Comstock
- Tammy J. Conrad
- Carolyn Lacy Cook
- Susan Cooper
- County of Dane Monona Grove School District
- Christina Marie Craven
- Jennifer Lynn Cummings
- Anthony J Curcio
- Molly Patricia Dillon Czech
All providers in Monona, WI · Speech-Language Pathologist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.