Provider Demographics
NPI:1710379169
Name:THOMPSON, JUDITH (ND)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4838 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4173
Mailing Address - Country:US
Mailing Address - Phone:503-314-9858
Mailing Address - Fax:
Practice Address - Street 1:4838 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4173
Practice Address - Country:US
Practice Address - Phone:503-314-9858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0092207175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath