Provider Demographics
NPI:1578772398
Name:THOMPSON, YVONNE M (SLP MS CCCSLP SPL)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:SLP MS CCCSLP SPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 WHITING AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481
Mailing Address - Country:US
Mailing Address - Phone:715-345-5350
Mailing Address - Fax:715-345-5966
Practice Address - Street 1:1640 WEST RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481
Practice Address - Country:US
Practice Address - Phone:715-342-0393
Practice Address - Fax:715-342-0391
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI614154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42708600Medicaid