Provider Demographics
NPI:1073691036
Name:THOMAS, STEPHANIE DIANA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DIANA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WATER ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347-1505
Mailing Address - Country:US
Mailing Address - Phone:207-622-0701
Mailing Address - Fax:207-622-0701
Practice Address - Street 1:210 WATER ST
Practice Address - Street 2:SUITE #1
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1505
Practice Address - Country:US
Practice Address - Phone:207-622-0701
Practice Address - Fax:207-622-0701
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESLP777235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist