Healthcare Provider Details

I. General information

NPI: 1255241071
Provider Name (Legal Business Name): ANGELA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 BELLEVUE AVE
SANTA ROSA CA
95407-7713
US

IV. Provider business mailing address

1037 HAMPSHIRE LN
WINDSOR CA
95492-8536
US

V. Phone/Fax

Practice location:
  • Phone: 707-890-3810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: