Individual
JACK E THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, SLP
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5176
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
01
—
P00746356
MEDICARE, RAILROAD
MN
Enumeration date
07/02/2009
Last updated
03/13/2018
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