Provider Demographics
NPI:1609956390
Name:THOMPSON, SALLETTE ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SALLETTE
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 W. BELLA CASA DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007
Mailing Address - Country:US
Mailing Address - Phone:907-590-9468
Mailing Address - Fax:530-548-7418
Practice Address - Street 1:1148 W. BELLA CASA DR.
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007
Practice Address - Country:US
Practice Address - Phone:907-590-9468
Practice Address - Fax:530-548-7418
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3289103TC0700X
COCO32891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical