1609945062 NPI number — MRS. MARY R. THOMPSON LMSW

Table of content: MRS. MARY R. THOMPSON LMSW (NPI 1609945062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609945062 NPI number — MRS. MARY R. THOMPSON LMSW

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609945062
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6216 KILGOUR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLETTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48453-1363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-635-2168
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 E. SANILAC
Provider Second Line Business Practice Location Address:
SUITE ONE
Provider Business Practice Location Address City Name:
SANDUSKY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-648-4450
Provider Business Practice Location Address Fax Number:
810-648-5833
Provider Enumeration Date:
11/07/2006

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: 1041C0700X , with the licence number:  6801059681 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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