Provider Demographics
NPI:1043879869
Name:THOMAS, MARSHELLE NICOLE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:MARSHELLE
Middle Name:NICOLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 HIGHWAY 59 LOOP S STE 104
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-9011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:440 HIGHWAY 59 LOOP S STE 104
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9011
Practice Address - Country:US
Practice Address - Phone:936-328-8148
Practice Address - Fax:936-327-2491
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist