Provider Demographics
NPI:1073922423
Name:THOMAS, KEARSTON
Entity Type:Individual
Prefix:
First Name:KEARSTON
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1555
Mailing Address - Country:US
Mailing Address - Phone:570-343-1950
Mailing Address - Fax:570-343-1951
Practice Address - Street 1:705 NANDY DR
Practice Address - Street 2:APT 5
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5656
Practice Address - Country:US
Practice Address - Phone:570-606-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011869235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist