Provider Demographics
NPI:1518795285
Name:THOMAS, CARLA JO (SLP-CCC)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:JO
Last Name:THOMAS
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 BOXWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:VA
Mailing Address - Zip Code:22963-5277
Mailing Address - Country:US
Mailing Address - Phone:434-960-4452
Mailing Address - Fax:
Practice Address - Street 1:2600 BARRACKS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-2271
Practice Address - Country:US
Practice Address - Phone:434-963-4198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist