Provider Demographics
NPI:1295853638
Name:THOMPSON, SANDRA SAMUELSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:SAMUELSON
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13801 E BENSON HWY
Mailing Address - Street 2:P.O. BOX 800
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-9074
Mailing Address - Country:US
Mailing Address - Phone:520-879-2061
Mailing Address - Fax:
Practice Address - Street 1:13801 E BENSON HWY
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-9074
Practice Address - Country:US
Practice Address - Phone:520-879-2061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool