Provider Demographics
NPI:1063551430
Name:THOMASON, LAUREL ELIZABETH
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:ELIZABETH
Last Name:THOMASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:ELIZABETH
Other - Last Name:THOMASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:12215 DEER TRL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8593
Mailing Address - Country:US
Mailing Address - Phone:706-998-9599
Mailing Address - Fax:
Practice Address - Street 1:11111 HOUZE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:770-998-9599
Practice Address - Fax:770-645-1313
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASPL006441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP006441OtherSLP