Basic Information
| Provider Information | |||||||||
| NPI: | 1619309572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | KHADIJAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9700 BISSONNET ST | ||||||||
| Address2: | STE 1000W | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770368001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328281005 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9700 BISSONNET ST | ||||||||
| Address2: | STE 1000W | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770368001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328281005 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2013 | ||||||||
| LastUpdateDate: | 05/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 111051 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.