Provider Demographics
NPI:1790273126
Name:THOMPSON, JANINE RUNYON
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:RUNYON
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 1:127 WOODROW WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-3407
Mailing Address - Country:US
Mailing Address - Phone:540-245-5040
Mailing Address - Fax:
Practice Address - Street 1:127 WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-3407
Practice Address - Country:US
Practice Address - Phone:540-245-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004904235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist