Provider Demographics
NPI:1285027953
Name:THOMPSON, CODI SUE (RDN, LD, CLC, CDE)
Entity Type:Individual
Prefix:
First Name:CODI
Middle Name:SUE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RDN, LD, CLC, CDE
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 1606
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-0197
Mailing Address - Country:US
Mailing Address - Phone:307-349-1804
Mailing Address - Fax:307-851-1465
Practice Address - Street 1:904 W SUNSET DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2307
Practice Address - Country:US
Practice Address - Phone:307-349-1804
Practice Address - Fax:307-851-1465
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY032133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered