Provider Demographics
NPI:1437836244
Name:THOMPSON, MANDI-MAE IRIS (LAC)
Entity Type:Individual
Prefix:
First Name:MANDI-MAE
Middle Name:IRIS
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GENERAL DELIVERY
Mailing Address - Street 2:326 SPRUCE CONE DR
Mailing Address - City:BIG SKY
Mailing Address - State:MT
Mailing Address - Zip Code:59716-9999
Mailing Address - Country:US
Mailing Address - Phone:402-613-0382
Mailing Address - Fax:
Practice Address - Street 1:320 EXPRESSWAY STE A
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1571
Practice Address - Country:US
Practice Address - Phone:402-613-0382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT117209171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist