Provider Demographics
NPI:1861362766
Name:THOMPSON, FELICIA M
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:M
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 1:265 S WOODLAND HILLS DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84653-2003
Mailing Address - Country:US
Mailing Address - Phone:801-808-2826
Mailing Address - Fax:
Practice Address - Street 1:265 S WOODLAND HILLS DR
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:UT
Practice Address - Zip Code:84653-2003
Practice Address - Country:US
Practice Address - Phone:801-808-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty