Individual
THOMAS SHORT BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SLP
Contact information
Practice address
BERKELEY COUNTY BOARD OF EDUCATION, 401 SOUTH QUEEN STREET, MARTINSBURG, WV 25401
(304) 267-3500
Mailing address
51 FINCH LN, FALLING WATERS, WV 25419-4030
(304) 274-9166
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7250
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0045683000
—
WV
Enumeration date
02/13/2008
Last updated
02/13/2008
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