Provider Demographics
NPI:1558423319
Name:THOMAS, CATHLEEN (DHSC,MACCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:CATHLEEN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DHSC,MACCC-SLP
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:MARIE
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCC-SLP
Mailing Address - Street 1:633 W 5TH ST OFC 2876B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90071-2005
Mailing Address - Country:US
Mailing Address - Phone:512-399-0064
Mailing Address - Fax:
Practice Address - Street 1:111 N ORANGE AVE STE 800
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2381
Practice Address - Country:US
Practice Address - Phone:512-399-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30001708235Z00000X
CA34551235Z00000X
MI7101007373235Z00000X
IN22005898A235Z00000X
FLSA17492235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist