Provider Demographics
NPI:1164428173
Name:THOMPSON, MARIA (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 US 31W BYP
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1775
Mailing Address - Country:US
Mailing Address - Phone:270-782-7768
Mailing Address - Fax:270-781-9480
Practice Address - Street 1:421 US 31W BYP
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1775
Practice Address - Country:US
Practice Address - Phone:270-782-7768
Practice Address - Fax:270-781-9480
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY273699231H00000X
CT000407231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4226602Medicaid
CT4226602Medicaid