Provider Demographics
NPI:1447566120
Name:FELLOWS, THELMA M (SLP)
Entity Type:Individual
Prefix:MS
First Name:THELMA
Middle Name:M
Last Name:FELLOWS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16306 CROCHERON AVE.
Mailing Address - Street 2:FL. 1
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2014
Mailing Address - Country:US
Mailing Address - Phone:718-460-6734
Mailing Address - Fax:718-460-6734
Practice Address - Street 1:16306 CROCHERON AVE.
Practice Address - Street 2:FL. 1
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2014
Practice Address - Country:US
Practice Address - Phone:718-460-6734
Practice Address - Fax:718-460-6734
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006339-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist