Provider Demographics
NPI:1447403902
Name:THOMPSON, BREANNE JOLEEN (LAC)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:JOLEEN
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 1:120 E BIRCH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3054
Mailing Address - Country:US
Mailing Address - Phone:509-520-7993
Mailing Address - Fax:509-527-9999
Practice Address - Street 1:120 E BIRCH ST STE 2
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3054
Practice Address - Country:US
Practice Address - Phone:509-520-7993
Practice Address - Fax:509-527-9999
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61122276171100000X
WAMA00021706225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist