Provider Demographics
NPI:1780076828
Name:THOMAS, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820 TERREY PINE CT STE 110
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1107
Mailing Address - Country:US
Mailing Address - Phone:952-594-8358
Mailing Address - Fax:952-479-4639
Practice Address - Street 1:7820 TERREY PINE CT
Practice Address - Street 2:SUITE 110
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-1104
Practice Address - Country:US
Practice Address - Phone:952-594-8358
Practice Address - Fax:952-479-4639
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8129237600000X, 231H00000X
MN237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400383286OtherMEDICARE