Provider Demographics
NPI:1578913125
Name:THOMAS, LAURA JAN (MA-CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JAN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA-CCC/SLP
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:JAN
Other - Last Name:HOLLIFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2165 KENNERLY RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8696
Mailing Address - Country:US
Mailing Address - Phone:803-732-9470
Mailing Address - Fax:
Practice Address - Street 1:2165 KENNERLY RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8696
Practice Address - Country:US
Practice Address - Phone:803-732-9470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3661235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist