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NPI Code Detail

MEDICARE: ALLIE THOMPSON M.A. CCC-SLP

MEDICARE: ALLIE THOMPSON M.A. CCC-SLP
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
1235Z00000XSpeech-Language Pathologist39890CA

General Provider Information

NPI Number : 1417889429
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLIE THOMPSON M.A. CCC-SLP
Provider Business Mailing Address
First Line : 690 W 18TH ST UNIT 1/2
Second Line :
City : COSTA MESA
State : CA
Zip : 92627-2714
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5050 BARRANCA PKWY
Second Line :
City : IRVINE
State : CA
Zip : 92604-4698
Country : US
Telephone Number : 949-255-3754
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2026
Last Update Date : 06/02/2026

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