Provider Demographics
NPI:1194192401
Name:THOMPSON, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
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:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54020-0817
Mailing Address - Country:US
Mailing Address - Phone:715-220-1942
Mailing Address - Fax:
Practice Address - Street 1:710 N MAIN ST STE 101B
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-3605
Practice Address - Country:US
Practice Address - Phone:715-417-3241
Practice Address - Fax:715-417-3243
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29421041C0700X
WI8381-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical