Provider Demographics
NPI:1003984691
Name:THOMAS, LAURIE BUNTEN
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:BUNTEN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SPEECH LANGUAGE PATH
Mailing Address - Street 1:4507 COMPOUND NORTH CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3463
Mailing Address - Country:US
Mailing Address - Phone:505-321-2799
Mailing Address - Fax:
Practice Address - Street 1:4507 COMPOUND NORTH CT NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-3463
Practice Address - Country:US
Practice Address - Phone:505-321-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM513235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1532Medicaid