Provider Demographics
NPI:1306275797
Name:THOMAS, JENNIFER (AUD, CCC-A)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 N DAVIS HWY
Mailing Address - Street 2:STE A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2344
Mailing Address - Country:US
Mailing Address - Phone:850-476-0700
Mailing Address - Fax:850-476-4300
Practice Address - Street 1:4900 N DAVIS HWY
Practice Address - Street 2:STE A
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2344
Practice Address - Country:US
Practice Address - Phone:850-476-0700
Practice Address - Fax:850-476-4300
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1136A231H00000X
FLAY 2010231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist