Kelly Suzanne Theis, M.S. SLP

Primary specialty

Local Education Agency (LEA)Taxonomy code 251300000X

License

018477 Issued in NY

Practice address

24 Idlewild Ave
Cornwall on Hudson, NY 12520-1134

Phone

(845) 534-8009

NPI assigned

Jan 12, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cornwall Central School District

  • Speech-Language Pathologist
  • Cornwall on Hudson, NY
  • NPI 1275879272
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326326400000",
    "number": "1851661433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 BETHLEHEM RD",
            "city": "NEW WINDSOR",
            "state": "NY",
            "postal_code": "125538903",
            "telephone_number": "845-863-7861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 IDLEWILD AVE",
            "city": "CORNWALL ON HUDSON",
            "state": "NY",
            "postal_code": "125201134",
            "telephone_number": "845-534-8009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEIS",
        "first_name": "KELLY",
        "middle_name": "SUZANNE",
        "name_prefix": "Mrs.",
        "credential": "M.S. SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-12",
        "last_updated": "2012-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "018477",
            "primary": false
        },
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": "NY",
            "license": "018477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Stathes, PT
• Ryan Patrick Stewart, RN
• Melissa Stoffa, LCSW
• Damaris Summo, LMT
• The Hudson Center
• Allen Tisch, M.D.
• Irene Vonestorff, MD
• Marie Warchol, LCSW
• Jennifer Sayegh Wilcox, MS, RDN, LDN
• Elizabeth Sarah Wingfield, CCC-SLP

• Local Education Agency (LEA) in Cornwall on Hudson, NY
• Providers in Cornwall on Hudson, NY by specialty
• Local Education Agency (LEA) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.