Provider Demographics
NPI:1255580411
Name:THOMAS, ELIZABETH ANN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:THOMAS
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 1:6979 E 250 S
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:IN
Mailing Address - Zip Code:46910-1914
Mailing Address - Country:US
Mailing Address - Phone:765-404-7074
Mailing Address - Fax:
Practice Address - Street 1:827 W 13TH ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-2502
Practice Address - Country:US
Practice Address - Phone:574-224-5370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004322A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist