Provider Demographics
NPI:1609135862
Name:THOMAS, STEPHANIE MICHELLE (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2286 COTTAGE LANE
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010
Mailing Address - Country:US
Mailing Address - Phone:405-401-0875
Mailing Address - Fax:405-756-8191
Practice Address - Street 1:2286 COTTAGE LANE
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010
Practice Address - Country:US
Practice Address - Phone:405-401-0875
Practice Address - Fax:405-756-8191
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3876235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist