Provider Demographics
NPI:1023008885
Name:LANDRY, THOMAS MATTHEW (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MATTHEW
Last Name:LANDRY
Suffix:
Gender:M
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 1:40 AMBROSE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-3516
Mailing Address - Country:US
Mailing Address - Phone:401-419-9284
Mailing Address - Fax:
Practice Address - Street 1:40 AMBROSE ST
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-3516
Practice Address - Country:US
Practice Address - Phone:401-419-9284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00714235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist