Healthcare Provider Details

I. General information

NPI: 1003033275
Provider Name (Legal Business Name): JENNIFER THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 STUDBURY HALL CT
WAKE FOREST NC
27587-9800
US

IV. Provider business mailing address

4820 STUDBURY HALL CT
WAKE FOREST NC
27587-9800
US

V. Phone/Fax

Practice location:
  • Phone: 919-609-5643
  • Fax:
Mailing address:
  • Phone: 919-609-5643
  • Fax: 919-400-4334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5864
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: