Provider Demographics
NPI:1124347372
Name:THOMPSON, ELIZA A (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 EL CENTRO ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5721
Mailing Address - Country:US
Mailing Address - Phone:626-441-4445
Mailing Address - Fax:626-441-4695
Practice Address - Street 1:1151 EL CENTRO ST
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-5721
Practice Address - Country:US
Practice Address - Phone:626-441-4445
Practice Address - Fax:626-441-4695
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP15641235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist