Healthcare Provider Details

I. General information

NPI: 1134398928
Provider Name (Legal Business Name): LISA THOMPSON AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W THOMAS RD STE 307
PHOENIX AZ
85013-4422
US

IV. Provider business mailing address

222 W THOMAS RD STE 307
PHOENIX AZ
85013-4422
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-8811
  • Fax:
Mailing address:
  • Phone: 602-406-8811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberDA1290
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: