Provider Demographics
NPI:1427381334
Name:THOMAS, JENNIFER ANN (MS,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MCDONALD AVE
Mailing Address - Street 2:APT 2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1082
Mailing Address - Country:US
Mailing Address - Phone:973-945-1640
Mailing Address - Fax:
Practice Address - Street 1:35 MCDONALD AVE
Practice Address - Street 2:APT 2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1082
Practice Address - Country:US
Practice Address - Phone:973-945-1640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013726235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist