Provider Demographics
NPI:1134837933
Name:THOMPSON, CHANNON (BS, QMHA-I)
Entity type:Individual
Prefix:
First Name:CHANNON
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:BS, QMHA-I
Other - Prefix:
Other - First Name:CHANNON
Other - Middle Name:
Other - Last Name:DEMPSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1144 GATEWAY LOOP STE 200
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-7706
Mailing Address - Country:US
Mailing Address - Phone:541-686-5060
Mailing Address - Fax:541-686-5063
Practice Address - Street 1:576 OLIVE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2642
Practice Address - Country:US
Practice Address - Phone:541-686-5060
Practice Address - Fax:541-686-5063
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker