Provider Demographics
NPI:1134332125
Name:STEPHENS, THOMAS R
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 EIGHTH AVE.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-1865
Mailing Address - Country:US
Mailing Address - Phone:610-691-2722
Mailing Address - Fax:610-691-2728
Practice Address - Street 1:1521 EIGHTH AVE.
Practice Address - Street 2:SUITE 203
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-1865
Practice Address - Country:US
Practice Address - Phone:610-691-2722
Practice Address - Fax:610-691-2728
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA002162237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist