Provider Demographics
NPI:1255477451
Name:THOMPSON, CARNETTA JOANN (MA,CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:CARNETTA
Middle Name:JOANN
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 1:4238 DE SOTO AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63107-1605
Mailing Address - Country:US
Mailing Address - Phone:314-534-0144
Mailing Address - Fax:
Practice Address - Street 1:4238 DE SOTO AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63107-1605
Practice Address - Country:US
Practice Address - Phone:314-534-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119875235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist