Provider Demographics
NPI:1114988839
Name:THOMAS PETERS, PAMELA S (SLP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:THOMAS PETERS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:THOMAS-PETERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:929 S. LOCUST STREET
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801
Mailing Address - Country:US
Mailing Address - Phone:308-382-9700
Mailing Address - Fax:308-382-9898
Practice Address - Street 1:1115 M ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NE
Practice Address - Zip Code:68818-2019
Practice Address - Country:US
Practice Address - Phone:402-694-5170
Practice Address - Fax:402-694-5178
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE894235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist