Provider Demographics
NPI:1407562556
Name:THOMPSON, SARAH ANN (CLC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12960 S 51ST ST
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-2924
Mailing Address - Country:US
Mailing Address - Phone:719-661-3036
Mailing Address - Fax:
Practice Address - Street 1:12960 S 51ST ST
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68133-2924
Practice Address - Country:US
Practice Address - Phone:719-661-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPP-340532174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN