Provider Demographics
NPI:1750503165
Name:THOMPSON, CHRISTOPHER L (MSW, APSW)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8810 W PETERSIK ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-4737
Mailing Address - Country:US
Mailing Address - Phone:414-324-4255
Mailing Address - Fax:414-353-7300
Practice Address - Street 1:4713 W LISBON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-1143
Practice Address - Country:US
Practice Address - Phone:414-431-2843
Practice Address - Fax:414-431-2165
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1266120-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43714700Medicare ID - Type UnspecifiedPSYCHOTHERAPY