Provider Demographics
NPI:1710542030
Name:THOMPSON, KRISTIN RAE
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RAE
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 1:1848 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4912
Mailing Address - Country:US
Mailing Address - Phone:970-702-1107
Mailing Address - Fax:
Practice Address - Street 1:1848 25TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4912
Practice Address - Country:US
Practice Address - Phone:970-702-1107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health