Provider Demographics
NPI:1770023533
Name:THOMPSON, DELENDTRICUS (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DELENDTRICUS
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059-2576
Mailing Address - Country:US
Mailing Address - Phone:601-672-3765
Mailing Address - Fax:
Practice Address - Street 1:302 N BENNETT ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-2576
Practice Address - Country:US
Practice Address - Phone:601-672-3765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist