Healthcare Provider Details

I. General information

NPI: 1992015416
Provider Name (Legal Business Name): ASHLEY PATRICE THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 FOXWORTH DR
COLUMBIA MS
39429-8269
US

IV. Provider business mailing address

103 FOXWORTH DR
COLUMBIA MS
39429-8269
US

V. Phone/Fax

Practice location:
  • Phone: 972-741-7500
  • Fax: 601-444-5036
Mailing address:
  • Phone: 972-741-7500
  • Fax: 601-444-5036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS3425
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: