Provider Demographics
NPI:1962173658
Name:THOMAS, SERENA SPRING (MAED)
Entity type:Individual
Prefix:MS
First Name:SERENA
Middle Name:SPRING
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:MRS
Other - First Name:SERENA
Other - Middle Name:SPRING
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:155 W 126TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-7310
Mailing Address - Country:US
Mailing Address - Phone:708-595-3201
Mailing Address - Fax:
Practice Address - Street 1:155 W 126TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-7310
Practice Address - Country:US
Practice Address - Phone:708-595-3201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist