Provider Demographics
NPI:1205598026
Name:THOMPSON, MICHELE DUNN
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:DUNN
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 1:216 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:RICH CREEK
Mailing Address - State:VA
Mailing Address - Zip Code:24147-9665
Mailing Address - Country:US
Mailing Address - Phone:540-235-6148
Mailing Address - Fax:
Practice Address - Street 1:401 WOLF ST
Practice Address - Street 2:
Practice Address - City:NARROWS
Practice Address - State:VA
Practice Address - Zip Code:24124-2152
Practice Address - Country:US
Practice Address - Phone:540-726-2391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2203000488235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2203000488Medicaid