Provider Demographics
NPI:1508580903
Name:THOMPSON, LENNARD
Entity Type:Individual
Prefix:
First Name:LENNARD
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8330 N 19TH AVE APT 2071
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5276
Mailing Address - Country:US
Mailing Address - Phone:347-854-2687
Mailing Address - Fax:
Practice Address - Street 1:8330 N 19TH AVE APT 2071
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5276
Practice Address - Country:US
Practice Address - Phone:347-854-2687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child