Provider Demographics
NPI:1437411915
Name:THUNDER, THOMAS DALTON (AUD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DALTON
Last Name:THUNDER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 SCOTTSDALE DR
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-5400
Mailing Address - Country:US
Mailing Address - Phone:847-359-1068
Mailing Address - Fax:847-359-1207
Practice Address - Street 1:867 SCOTTSDALE DR
Practice Address - Street 2:
Practice Address - City:PINGREE GROVE
Practice Address - State:IL
Practice Address - Zip Code:60140-5400
Practice Address - Country:US
Practice Address - Phone:847-359-1068
Practice Address - Fax:847-359-1207
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.000086231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist