Provider Demographics
NPI:1376271692
Name:THOMPSON, CHEYENNE MARY (MSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:CHEYENNE
Middle Name:MARY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:CHEYENNE
Other - Middle Name:MARY
Other - Last Name:SMOLKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:396 FOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SNOW SHOE
Mailing Address - State:PA
Mailing Address - Zip Code:16874-8809
Mailing Address - Country:US
Mailing Address - Phone:814-571-6165
Mailing Address - Fax:
Practice Address - Street 1:1315 S ALLEN ST STE 303
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5946
Practice Address - Country:US
Practice Address - Phone:814-419-5463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW139323104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker