Provider Demographics
NPI:1841504255
Name:THOMPSON, LILLIAN EDITH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:EDITH
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 1:3860 LOMBARDY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3031
Mailing Address - Country:US
Mailing Address - Phone:954-985-8270
Mailing Address - Fax:
Practice Address - Street 1:3860 LOMBARDY ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3031
Practice Address - Country:US
Practice Address - Phone:954-985-8270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105452235Z00000X
FL10195235Z00000X
IL146011869235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist