Provider Demographics
NPI:1154112258
Name:THOMPSON, OLIVIA GUNNISON
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:GUNNISON
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 1:312 E 30TH ST APT 15B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8333
Mailing Address - Country:US
Mailing Address - Phone:817-505-5351
Mailing Address - Fax:
Practice Address - Street 1:312 E 30TH ST APT 15B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8333
Practice Address - Country:US
Practice Address - Phone:817-505-5351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist