Provider Demographics
NPI:1295323483
Name:THOMAS, NWAKAEGO IWENOFU (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:NWAKAEGO
Middle Name:IWENOFU
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MRS
Other - First Name:NWAKAEGO
Other - Middle Name:OV
Other - Last Name:IWENOFU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-CLP
Mailing Address - Street 1:804 LANCASTER LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-8820
Mailing Address - Country:US
Mailing Address - Phone:757-898-0231
Mailing Address - Fax:757-898-0231
Practice Address - Street 1:804 LANCASTER LN
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-8820
Practice Address - Country:US
Practice Address - Phone:757-898-0231
Practice Address - Fax:757-898-0231
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty