Provider Demographics
NPI:1831686930
Name:THOMS, JENNIFER C (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:THOMS
Suffix:
Gender:F
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 1:142 N VIENNA AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08215-3243
Mailing Address - Country:US
Mailing Address - Phone:609-515-5882
Mailing Address - Fax:
Practice Address - Street 1:142 N VIENNA AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08215-3243
Practice Address - Country:US
Practice Address - Phone:609-515-5882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00567400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41YS00567400OtherNEW JERSEY STATE LICENSE: SPEECH-LANGUAGE PATHOLOGIST