Provider Demographics
NPI:1952900458
Name:THOMAS, EMILY MORGAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MORGAN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 W LAKE HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-9269
Mailing Address - Country:US
Mailing Address - Phone:863-651-7573
Mailing Address - Fax:
Practice Address - Street 1:4141 ASHTON CLUB DR
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33859-5703
Practice Address - Country:US
Practice Address - Phone:863-324-5810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11434235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist