Provider Demographics
NPI:1356925200
Name:THOMPSON, DEAIRRA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DEAIRRA
Middle Name:
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 1:174 SUNBURST VILLA DR
Mailing Address - Street 2:
Mailing Address - City:EVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24550-7700
Mailing Address - Country:US
Mailing Address - Phone:276-768-7314
Mailing Address - Fax:
Practice Address - Street 1:174 SUNBURST VILLA DR
Practice Address - Street 2:
Practice Address - City:EVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24550-7700
Practice Address - Country:US
Practice Address - Phone:276-768-7314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202010303235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist