Provider Demographics
NPI:1891771796
Name:THOMAS BRIDGES, LASHAWN (SLPD)
Entity Type:Individual
Prefix:
First Name:LASHAWN
Middle Name:
Last Name:THOMAS BRIDGES
Suffix:
Gender:F
Credentials:SLPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 TWO NOTCH RD # 150
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4395
Mailing Address - Country:US
Mailing Address - Phone:803-462-0597
Mailing Address - Fax:803-462-0597
Practice Address - Street 1:10120 TWO NOTCH RD # 150
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4395
Practice Address - Country:US
Practice Address - Phone:803-429-2327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3693235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0668Medicaid