Provider Demographics
NPI: | 1518650050 |
---|---|
Name: | THOMPSON, DEDRA |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | DEDRA |
Middle Name: | |
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: | 7815 W 28TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | LITTLE ROCK |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72204-4605 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 501-471-8580 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7815 W 28TH ST |
Practice Address - Street 2: | |
Practice Address - City: | LITTLE ROCK |
Practice Address - State: | AR |
Practice Address - Zip Code: | 72204-4605 |
Practice Address - Country: | US |
Practice Address - Phone: | 501-471-8988 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2023-05-31 |
Last Update Date: | 2023-05-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
3747A0650X, 225800000X | ||
AR | 3747P1801X, 385HR2060X, 106S00000X, 103K00000X, 106E00000X, 171000000X, 174H00000X, 221700000X, 252Y00000X, 332BC3200X, 222Q00000X, 251C00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | |
No | 3747A0650X | Nursing Service Related Providers | Technician | Attendant Care Provider |
No | 3747P1801X | Nursing Service Related Providers | Technician | Personal Care Attendant |
No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | |
No | 106E00000X | Behavioral Health & Social Service Providers | Assistant Behavior Analyst | |
No | 171000000X | Other Service Providers | Military Health Care Provider | |
No | 174H00000X | Other Service Providers | Health Educator | |
No | 221700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist | |
No | 252Y00000X | Agencies | Early Intervention Provider Agency | |
No | 332BC3200X | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
No | 222Q00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | |
No | 225800000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Recreation Therapist | |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services |