Provider Demographics
NPI:1144234220
Name:THOMPSON, KATHRYN M (MA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA
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 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-235-5390
Mailing Address - Fax:319-233-1630
Practice Address - Street 1:1753 W RIDGEWAY AVE STE 111
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701
Practice Address - Country:US
Practice Address - Phone:319-833-5970
Practice Address - Fax:319-833-5971
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA865237700000X
IA558231H00000X
IL147001127231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA211928OtherIOWA HEALTH SOLUTIONS
IA0236778Medicaid
IA05573OtherNATIONAL EAR CARE PLAN
ILL90980Medicare ID - Type Unspecified
IAI4506Medicare ID - Type Unspecified