Provider Demographics
NPI:1093184871
Name:THOMPSON, ILA KAREN
Entity Type:Individual
Prefix:
First Name:ILA
Middle Name:KAREN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 RED OAK CT
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33898-8492
Mailing Address - Country:US
Mailing Address - Phone:336-618-0059
Mailing Address - Fax:
Practice Address - Street 1:3808 RED OAK CT
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33898-8492
Practice Address - Country:US
Practice Address - Phone:336-618-0059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker