Provider Demographics
NPI:1205549847
Name:THOMPSON, ISABELLA R (LSW)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 N TRIPP AVE APT 1W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2028
Mailing Address - Country:US
Mailing Address - Phone:616-648-1553
Mailing Address - Fax:
Practice Address - Street 1:4311 N RAVENSWOOD AVENUE
Practice Address - Street 2:FLOOR 3 #326
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1192
Practice Address - Country:US
Practice Address - Phone:847-865-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.109934104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker