Provider Demographics
NPI:1093102568
Name:THOMAS, CONNIE LEE
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:LEE
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 1:37 WOODLANDS DRIVE
Mailing Address - Street 2:
Mailing Address - City:WAYMART
Mailing Address - State:PA
Mailing Address - Zip Code:18472
Mailing Address - Country:US
Mailing Address - Phone:570-488-9884
Mailing Address - Fax:
Practice Address - Street 1:37 WOODLANDS DRIVE
Practice Address - Street 2:
Practice Address - City:WAYMART
Practice Address - State:PA
Practice Address - Zip Code:18472
Practice Address - Country:US
Practice Address - Phone:570-488-9884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000169L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist