Provider Demographics
NPI:1609214949
Name:THOMPSON, TRINA GOULD (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:GOULD
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 JANE RD
Mailing Address - Street 2:APT. 2
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36079-3052
Mailing Address - Country:US
Mailing Address - Phone:334-447-9139
Mailing Address - Fax:
Practice Address - Street 1:419 JANE RD
Practice Address - Street 2:APT. 2
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36079-3052
Practice Address - Country:US
Practice Address - Phone:334-447-9139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-09
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL943A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL175048Medicaid