Provider Demographics
NPI:1316195811
Name:THOMPSON, DIANA D (SLP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:D
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13027 PRICEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CUB RUN
Mailing Address - State:KY
Mailing Address - Zip Code:42729-8803
Mailing Address - Country:US
Mailing Address - Phone:270-524-2973
Mailing Address - Fax:
Practice Address - Street 1:13027 PRICEVILLE RD
Practice Address - Street 2:
Practice Address - City:CUB RUN
Practice Address - State:KY
Practice Address - Zip Code:42729-8803
Practice Address - Country:US
Practice Address - Phone:270-524-2973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist