Individual
DR. THOMAS LAURIE SOUTHERN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SLPD
Contact information
Practice address
53359 CHAMPLAIN ST, MACOMB, MI 48042-3739
(586) 859-9607
Mailing address
53359 CHAMPLAIN ST, MACOMB, MI 48042-3739
(586) 859-9607
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101001203
MI
Other
Enumeration date
04/24/2020
Last updated
06/02/2020
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