Provider Demographics
NPI:1295798106
Name:THOMAS, BRUCE E (SPEECH PATHOLOGY)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:E
Last Name:THOMAS
Suffix:
Gender:M
Credentials:SPEECH PATHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9095
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96538
Mailing Address - Country:UM
Mailing Address - Phone:671-344-9679
Mailing Address - Fax:671-344-9305
Practice Address - Street 1:BOX 9095
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96538
Practice Address - Country:UM
Practice Address - Phone:671-344-9679
Practice Address - Fax:671-344-9305
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10649235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist