Provider Demographics
NPI:1972681310
Name:THOMPSON, ANGELA MARIE (LLP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:CANUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLP
Mailing Address - Street 1:2735 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-7939
Mailing Address - Country:US
Mailing Address - Phone:269-870-7757
Mailing Address - Fax:
Practice Address - Street 1:1606 S BURDICK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2712
Practice Address - Country:US
Practice Address - Phone:269-552-3440
Practice Address - Fax:269-552-5586
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012672103TC0700X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator