Provider Demographics
NPI:1508021148
Name:TOMPKINS, DAVID JON (SLP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JON
Last Name:TOMPKINS
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 CLEVELAND AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4763
Mailing Address - Country:US
Mailing Address - Phone:704-608-0708
Mailing Address - Fax:
Practice Address - Street 1:1621 CLEVELAND AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4763
Practice Address - Country:US
Practice Address - Phone:704-608-0708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0003111235Z00000X
NC6174235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty