Provider Demographics
NPI:1629364567
Name:THOMAS, SUE ANNE (MS, CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:ANNE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS, CCC, SLP
Other - Prefix:MRS
Other - First Name:SUE
Other - Middle Name:ANNE
Other - Last Name:PALLESCHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2432 OSBORNE RD
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-8730
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2432 OSBORNE RD
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037-8730
Practice Address - Country:US
Practice Address - Phone:315-876-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018421235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist