Provider Demographics
NPI:1679774913
Name:THOMPSON, KATHY WILLIAMS (SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:WILLIAMS
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 SW 5TH CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-2011
Mailing Address - Country:US
Mailing Address - Phone:954-726-9536
Mailing Address - Fax:
Practice Address - Street 1:3066 JOG RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-2053
Practice Address - Country:US
Practice Address - Phone:561-357-5884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist