Provider Demographics
NPI:1235322454
Name:EHREN, TOM CHRISTOPHER (MS)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:CHRISTOPHER
Last Name:EHREN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 CAYUGA DR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5604
Mailing Address - Country:US
Mailing Address - Phone:407-971-0748
Mailing Address - Fax:
Practice Address - Street 1:12424 RESEARCH PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-3249
Practice Address - Country:US
Practice Address - Phone:407-882-0468
Practice Address - Fax:407-249-4774
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA1953OtherPROFESSIONAL LICENSE