Provider Demographics
NPI:1598244287
Name:THOMAS, TERRI LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LYNN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 QUAIL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-2786
Mailing Address - Country:US
Mailing Address - Phone:618-670-6770
Mailing Address - Fax:
Practice Address - Street 1:111 W ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:MORO
Practice Address - State:IL
Practice Address - Zip Code:62067-1545
Practice Address - Country:US
Practice Address - Phone:618-377-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist