Provider Demographics
NPI:1467164301
Name:NELSON, THOMAS ROY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROY
Last Name:NELSON
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 LONGWATER CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1643
Mailing Address - Country:US
Mailing Address - Phone:781-792-2700
Mailing Address - Fax:781-792-2700
Practice Address - Street 1:99 LONGWATER CIR STE 100
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1643
Practice Address - Country:US
Practice Address - Phone:781-792-2700
Practice Address - Fax:781-792-2700
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASLP100015235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist