Provider Demographics
NPI:1225314123
Name:THOMAS, TANESHA DEYVONNE (MA SLP CCC)
Entity Type:Individual
Prefix:
First Name:TANESHA
Middle Name:DEYVONNE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5413 HIGHWAY 531
Mailing Address - Street 2:
Mailing Address - City:DUBBERLY
Mailing Address - State:LA
Mailing Address - Zip Code:71024-2949
Mailing Address - Country:US
Mailing Address - Phone:318-377-9679
Mailing Address - Fax:
Practice Address - Street 1:5413 HIGHWAY 531
Practice Address - Street 2:
Practice Address - City:DUBBERLY
Practice Address - State:LA
Practice Address - Zip Code:71024-2949
Practice Address - Country:US
Practice Address - Phone:318-377-9679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6234235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist