Provider Demographics
NPI:1356773253
Name:THOMAS, BERNELDA JANESSA (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:BERNELDA
Middle Name:JANESSA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS CCC-SLP
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Mailing Address - Street 1:2840 NW 2ND AVENUE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431
Mailing Address - Country:US
Mailing Address - Phone:561-989-8595
Mailing Address - Fax:561-989-8476
Practice Address - Street 1:2840 NW 2ND AVENUE
Practice Address - Street 2:SUITE 104
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-989-8595
Practice Address - Fax:561-989-8476
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN4834235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4834OtherTN BOARD OF HEALTH
TN14038466OtherASHA