Provider Demographics
NPI:1518088798
Name:THOMPSON, PEG (PH D)
Entity Type:Individual
Prefix:
First Name:PEG
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:ANNE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:7790 S WELLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122
Mailing Address - Country:US
Mailing Address - Phone:303-798-4314
Mailing Address - Fax:
Practice Address - Street 1:7790 S WELLINGTON ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122
Practice Address - Country:US
Practice Address - Phone:303-798-4314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3292103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging