1659669943 NPI number — MRS. LARUE MAY THOMAS SLP MS CCC-SLP

Table of content: MRS. LARUE MAY THOMAS SLP MS CCC-SLP (NPI 1659669943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659669943 NPI number — MRS. LARUE MAY THOMAS SLP MS CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
LARUE
Provider Middle Name:
MAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SLP MS CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KEATON
Provider Other First Name:
LARUE
Provider Other Middle Name:
MAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
SLP MS CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659669943
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 COURTNEY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76015-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-460-4000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 COURTNEY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76015-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-460-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  12750 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12750 . This is a "STATE BOARD OF EXAMINERS FOR SLP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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