Provider Demographics
NPI:1770298085
Name:THOMPSON, MICHELLE ELIZABETH (MS, CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 W DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:MC NEAL
Mailing Address - State:AZ
Mailing Address - Zip Code:85617-9631
Mailing Address - Country:US
Mailing Address - Phone:480-242-8493
Mailing Address - Fax:
Practice Address - Street 1:3876 W DAVIS RD
Practice Address - Street 2:
Practice Address - City:MC NEAL
Practice Address - State:AZ
Practice Address - Zip Code:85617-9631
Practice Address - Country:US
Practice Address - Phone:480-242-8493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP14278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist