Provider Demographics
NPI:1770063521
Name:THOMAS, STEPHANIE M (CCC-SLP, QOM)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CCC-SLP, QOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10979 W TIDEWATER CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1138
Mailing Address - Country:US
Mailing Address - Phone:208-340-1642
Mailing Address - Fax:
Practice Address - Street 1:13075 W PERSIMMON LN STE 120
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1986
Practice Address - Country:US
Practice Address - Phone:208-376-3591
Practice Address - Fax:208-376-3594
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist