Provider Demographics
NPI:1649333964
Name:AFFHOLDER, THOMAS GEORGE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:GEORGE
Last Name:AFFHOLDER
Suffix:
Gender:M
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 1:427 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-1923
Mailing Address - Country:US
Mailing Address - Phone:419-523-4319
Mailing Address - Fax:
Practice Address - Street 1:1880 N PERRY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1129
Practice Address - Country:US
Practice Address - Phone:419-523-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP2358235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist