Provider Demographics
NPI:1902188675
Name:THOMAS, BRIDGET (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:
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 1:94 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12057-2422
Mailing Address - Country:US
Mailing Address - Phone:518-686-7126
Mailing Address - Fax:
Practice Address - Street 1:94 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:EAGLE BRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12057-2422
Practice Address - Country:US
Practice Address - Phone:518-686-7126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020675235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist