Provider Demographics
NPI:1841724747
Name:THOMAS, PATRICE
Entity type:Individual
Prefix:
First Name:PATRICE
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:PO BOX 135
Mailing Address - Street 2:96 BACONIA RD.
Mailing Address - City:CARY
Mailing Address - State:MS
Mailing Address - Zip Code:39054
Mailing Address - Country:US
Mailing Address - Phone:601-415-4439
Mailing Address - Fax:
Practice Address - Street 1:96 BACONIA RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:MS
Practice Address - Zip Code:39054
Practice Address - Country:US
Practice Address - Phone:601-415-4439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist