Provider Demographics
NPI:1205994829
Name:THOMAS, JANICE (SA 619)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:SA 619
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4146 CONWAY PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-7989
Mailing Address - Country:US
Mailing Address - Phone:407-383-2019
Mailing Address - Fax:407-386-3395
Practice Address - Street 1:4146 CONWAY PLACE CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-7989
Practice Address - Country:US
Practice Address - Phone:407-383-2019
Practice Address - Fax:407-386-3395
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 619235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL881906800Medicaid