Provider Demographics
NPI:1225427461
Name:THOMPSON, ELLEN (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-3746
Mailing Address - Country:US
Mailing Address - Phone:937-244-0071
Mailing Address - Fax:937-323-6207
Practice Address - Street 1:818 WELLINGTON DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45506-3746
Practice Address - Country:US
Practice Address - Phone:937-244-0071
Practice Address - Fax:937-323-6207
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4016133VN1006X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic