Provider Demographics
NPI:1104040187
Name:WHYLDTHOMAS, NONIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:NONIE
Middle Name:
Last Name:WHYLDTHOMAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 ROLLING MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8871
Mailing Address - Country:US
Mailing Address - Phone:610-351-4104
Mailing Address - Fax:610-965-7078
Practice Address - Street 1:5182 LAURIE DR
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-5054
Practice Address - Country:US
Practice Address - Phone:610-965-2458
Practice Address - Fax:610-965-7078
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008356235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018507650001OtherMEDICAL ASSISTANCE