Provider Demographics
NPI:1427421403
Name:THACH, RAMONA
Entity type:Individual
Prefix:
First Name:RAMONA
Middle Name:
Last Name:THACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARK DR
Mailing Address - Street 2:STE A
Mailing Address - City:HOLIDAY ISLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72631-9405
Mailing Address - Country:US
Mailing Address - Phone:479-363-6422
Mailing Address - Fax:479-363-6763
Practice Address - Street 1:1 PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:HOLIDAY ISLAND
Practice Address - State:AR
Practice Address - Zip Code:72631-9216
Practice Address - Country:US
Practice Address - Phone:479-363-6422
Practice Address - Fax:479-363-6763
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#3100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist