Provider Demographics
NPI:1952409468
Name:THOMPSON, REBECCA L (BC-HIS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16301 STATE HIGHWAY 305 NE
Mailing Address - Street 2:SITE 121
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7883
Mailing Address - Country:US
Mailing Address - Phone:360-626-3407
Mailing Address - Fax:
Practice Address - Street 1:9995 SILVERDALE WAY NW
Practice Address - Street 2:SUITE 103
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9454
Practice Address - Country:US
Practice Address - Phone:360-692-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA00002618237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA207657OtherSTATE L&I