Provider Demographics
NPI:1689978728
Name:THOMAS, JENNIFER (BA, SLP-A)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:BA, SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 E 75TH ST
Mailing Address - Street 2:SUITE 152
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2777
Mailing Address - Country:US
Mailing Address - Phone:317-578-0410
Mailing Address - Fax:317-578-0520
Practice Address - Street 1:6330 E 75TH ST
Practice Address - Street 2:SUITE 152
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2777
Practice Address - Country:US
Practice Address - Phone:317-578-0410
Practice Address - Fax:317-578-0520
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst