Provider Demographics
NPI:1477272433
Name:THOMAS, AUSTIN (CF-SLP)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 MAHAFFEY DR APT A8
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2435
Mailing Address - Country:US
Mailing Address - Phone:336-262-0329
Mailing Address - Fax:
Practice Address - Street 1:2168 FRANKFORT RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9434
Practice Address - Country:US
Practice Address - Phone:502-863-3663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY279639235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1922158088Medicaid