Healthcare Provider Details

I. General information

NPI: 1841751963
Provider Name (Legal Business Name): HEATHER THOMAS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 DISTRICT CENTER DR
PALM SPRINGS CA
92264-3626
US

IV. Provider business mailing address

12400 HIGH BLUFF DR
SAN DIEGO CA
92130-3077
US

V. Phone/Fax

Practice location:
  • Phone: 760-883-2700
  • Fax:
Mailing address:
  • Phone: 858-792-0711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL61521987
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number33523
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: