Provider Demographics
NPI:1710279310
Name:THOMAS, EMILY RADKE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:RADKE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 EMPRESS DR
Mailing Address - Street 2:APT: C-301
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-1285
Mailing Address - Country:US
Mailing Address - Phone:615-210-3816
Mailing Address - Fax:
Practice Address - Street 1:209 CASTLEWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-5163
Practice Address - Country:US
Practice Address - Phone:615-898-7461
Practice Address - Fax:615-898-7490
Is Sole Proprietor?:No
Enumeration Date:2011-05-14
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP 0000004119235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist