Provider Demographics
NPI:1326296237
Name:THOMAS, ELLEN SMITH (CCC/LSLS CERT AVT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:SMITH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CCC/LSLS CERT AVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 MARKET PL
Mailing Address - Street 2:BUILDING 1, SUITE A
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1649
Mailing Address - Country:US
Mailing Address - Phone:734-998-8119
Mailing Address - Fax:734-998-8122
Practice Address - Street 1:475 MARKET PL
Practice Address - Street 2:BUILDING 1, SUITE A
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1649
Practice Address - Country:US
Practice Address - Phone:734-998-8119
Practice Address - Fax:734-998-8122
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist