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NPI Code Detail

MEDICARE: LACEY THERESA THOMPSON MSW, LICSW

MEDICARE:   LACEY THERESA THOMPSON  MSW, LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker

General Provider Information

NPI Number : 1295271971
Entity Type Code : Individual
Provider Name (Legal Business Name) : LACEY THERESA THOMPSON MSW, LICSW
Provider Business Mailing Address
First Line : 2419 MAPLE AVE
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-7155
Country : US
Telephone Number : 651-249-0047
Fax Number :
Provider Business Practice Location Address
First Line : 202 N CEDAR AVE STE 1
Second Line :
City : OWATONNA
State : MN
Zip : 55060-2306
Country : US
Telephone Number : 651-249-0047
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2017
Last Update Date : 02/17/2026

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Directions to “ LACEY THERESA THOMPSON MSW, LICSW” Practice Location

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