Provider Demographics
NPI:1124190046
Name:THOMPSON, KIMBERLEY D (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:D
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:54011-0670
Mailing Address - Country:US
Mailing Address - Phone:715-273-6770
Mailing Address - Fax:715-273-6862
Practice Address - Street 1:230 DERONDA ST
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-1412
Practice Address - Country:US
Practice Address - Phone:715-268-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6956-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP69910OtherHEALTHPARTNERS
MN920461025361OtherPREFERRED ONE
MN99F89THOtherBLUECROSS BLUESHIELD
WI43585400Medicaid
WI0011Medicare ID - Type UnspecifiedMENTAL HEALTH AND AODA