Provider Demographics
NPI:1376869545
Name:THOMAS, LAURA WHITLEY (MSED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:WHITLEY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 CUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2648
Mailing Address - Country:US
Mailing Address - Phone:757-617-9753
Mailing Address - Fax:
Practice Address - Street 1:615 SOUTHPOINTE CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3855
Practice Address - Country:US
Practice Address - Phone:719-579-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12141668235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist