Provider Demographics
NPI:1861460842
Name:THOMAS, HEATHER I (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:I
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 1:405 GOLDEN EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1273
Mailing Address - Country:US
Mailing Address - Phone:720-339-1699
Mailing Address - Fax:
Practice Address - Street 1:405 GOLDEN EAGLE DR
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1273
Practice Address - Country:US
Practice Address - Phone:720-339-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58437240Medicaid