Provider Demographics
NPI:1043561475
Name:MOCK, LINDA THOMAS (MA CCC/A)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:THOMAS
Last Name:MOCK
Suffix:
Gender:F
Credentials:MA CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WAKE FOREST BAPTIST HOSPITAL
Mailing Address - Street 2:MEDICAL CENTER BLVD
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-1189
Mailing Address - Country:US
Mailing Address - Phone:336-716-3103
Mailing Address - Fax:336-716-8161
Practice Address - Street 1:WAKE FOREST BAPTIST HOSPITAL
Practice Address - Street 2:MEDICAL CENTER BLVD
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1189
Practice Address - Country:US
Practice Address - Phone:336-716-3103
Practice Address - Fax:336-716-8161
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1114231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist