Provider Demographics
NPI:1871860544
Name:THOMAS SPEECH THERAPY SERVICES PLLC
Entity Type:Organization
Organization Name:THOMAS SPEECH THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:910-612-1002
Mailing Address - Street 1:1176 WOODBRIDGE LN SE
Mailing Address - Street 2:
Mailing Address - City:BOLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28422-8969
Mailing Address - Country:US
Mailing Address - Phone:910-612-1002
Mailing Address - Fax:910-755-5865
Practice Address - Street 1:20 MEDICAL CAMPUS DR
Practice Address - Street 2:SUITE 204
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4096
Practice Address - Country:US
Practice Address - Phone:910-612-1002
Practice Address - Fax:910-755-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-24
Last Update Date:2011-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty