Provider Demographics
NPI:1720749484
Name:THOMPSON, ELIZA RUTH
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:RUTH
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 1:930 MILLSTREAM WAY
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-2118
Mailing Address - Country:US
Mailing Address - Phone:801-499-0907
Mailing Address - Fax:
Practice Address - Street 1:70 N MAIN ST STE AND104
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6101
Practice Address - Country:US
Practice Address - Phone:801-298-5222
Practice Address - Fax:801-294-0295
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical