Provider Demographics
NPI:1679609572
Name:THOMPSON, ANTOINETTE
Entity Type:Individual
Prefix:MRS
First Name:ANTOINETTE
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 1:1939 BALMORAL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-4309
Mailing Address - Country:US
Mailing Address - Phone:708-574-4903
Mailing Address - Fax:708-356-6456
Practice Address - Street 1:1939 BALMORAL AVE
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-4309
Practice Address - Country:US
Practice Address - Phone:708-574-4903
Practice Address - Fax:708-356-6456
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist