Provider Demographics
NPI:1174276802
Name:THOMPSON, BRIANNE ELYSE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:ELYSE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20021 205TH AVE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-8939
Mailing Address - Country:US
Mailing Address - Phone:641-216-3006
Mailing Address - Fax:
Practice Address - Street 1:20021 205TH AVE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-8939
Practice Address - Country:US
Practice Address - Phone:641-216-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1971235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty