Doctor Name: | FAYTRENE THOMAS |
NPI Number: | 1740420694 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSE., CCC-SP |
License Number: | 461 |
Business Practice Address: | 318 W 24th Ave Pine Bluff, AR - 716017811 |
Business Phone Number: | 8705364369 |
Business Fax Number: | 8705364369 |
Mailing Address: | 318 W 24th Ave, PINE BLUFF |
State: | AR |
Postal Code: | 716017811 |
Phone Number: | 8705364369 |
Fax Number: | 8705364369 |
NPI Enumeration Date: | 03/04/2009 |
NPI Last Update Date: | 03/04/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 461 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |