Provider Demographics
NPI:1952041089
Name:THOMPSON, PENNY SUE
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:SUE
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 1:290 MAPLE STREET
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63944
Mailing Address - Country:US
Mailing Address - Phone:573-868-8010
Mailing Address - Fax:
Practice Address - Street 1:290 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MO
Practice Address - Zip Code:63944
Practice Address - Country:US
Practice Address - Phone:573-868-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician