Provider Demographics
NPI:1508896606
Name:THOMPSON, DAVID WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 W. CHESTNUT ST., STE 100
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1200
Mailing Address - Country:US
Mailing Address - Phone:262-763-9191
Mailing Address - Fax:262-763-7767
Practice Address - Street 1:197 W. CHESTNUT ST., STE 100
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1200
Practice Address - Country:US
Practice Address - Phone:262-763-9191
Practice Address - Fax:262-763-7767
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1588-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39090800Medicaid
WI84596Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER