Provider Demographics
NPI:1548601669
Name:THOMAS, JUDE ELIZABETH (SLP)
Entity Type:Individual
Prefix:
First Name:JUDE
Middle Name:ELIZABETH
Last Name:THOMAS
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 1:515 W WRIGHTWOOD AVE
Mailing Address - Street 2:211
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1870
Mailing Address - Country:US
Mailing Address - Phone:502-777-9373
Mailing Address - Fax:
Practice Address - Street 1:515 W WRIGHTWOOD AVE
Practice Address - Street 2:211
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1870
Practice Address - Country:US
Practice Address - Phone:502-777-9373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242002707235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist