Provider Demographics
NPI:1013299932
Name:THOMAS, JESSIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
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 1:358 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1635
Mailing Address - Country:US
Mailing Address - Phone:585-247-5050
Mailing Address - Fax:585-340-5571
Practice Address - Street 1:3 SPARTAN WAY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1448
Practice Address - Country:US
Practice Address - Phone:585-247-5050
Practice Address - Fax:585-340-5571
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016134-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist