Provider Demographics
NPI:1003953209
Name:THOMASSON, WENDI LYNN
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:LYNN
Last Name:THOMASSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 JAMESTOWN FARM DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-1402
Mailing Address - Country:US
Mailing Address - Phone:314-954-6559
Mailing Address - Fax:
Practice Address - Street 1:21 JAMESTOWN FARM DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-1402
Practice Address - Country:US
Practice Address - Phone:314-954-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105702235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist