Provider Demographics
NPI:1477294908
Name:THOMPSON, MONIKA EVA
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:EVA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-1805
Mailing Address - Country:US
Mailing Address - Phone:503-487-7926
Mailing Address - Fax:
Practice Address - Street 1:571 BRAUND ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8556
Practice Address - Country:US
Practice Address - Phone:608-785-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27473104100000X
WI131005104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker