Provider Demographics
NPI:1942346739
Name:THOMAS, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 E HWY 50 STE 202
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5199
Mailing Address - Country:US
Mailing Address - Phone:408-580-3084
Mailing Address - Fax:407-295-4195
Practice Address - Street 1:1645 E HWY 50 STE 202
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5199
Practice Address - Country:US
Practice Address - Phone:408-580-3084
Practice Address - Fax:407-295-4195
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7807235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889855300Medicaid