1376271692 NPI number — MRS. CHEYENNE MARY THOMPSON MSW, LSW

Table of content: MRS. CHEYENNE MARY THOMPSON MSW, LSW (NPI 1376271692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376271692 NPI number — MRS. CHEYENNE MARY THOMPSON MSW, LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
CHEYENNE
Provider Middle Name:
MARY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMOLKO
Provider Other First Name:
CHEYENNE
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376271692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
396 FOUNTAIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SNOW SHOE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16874-8809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-571-6165
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1315 S ALLEN ST STE 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-5946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-419-5463
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  SW139323 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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