Provider Demographics
NPI:1467258988
Name:THOMAS, MAYA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 WILSHIRE BLVD APT 817
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3125
Mailing Address - Country:US
Mailing Address - Phone:323-767-3590
Mailing Address - Fax:
Practice Address - Street 1:1027 WILSHIRE BLVD APT 817
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3125
Practice Address - Country:US
Practice Address - Phone:323-767-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist