Healthcare Provider Details

I. General information

NPI: 1003789702
Provider Name (Legal Business Name): HEATHER THOMPSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 MIRAGE ST # 1041
YORBA LINDA CA
92887-4607
US

IV. Provider business mailing address

5511 MIRAGE ST # 1041
YORBA LINDA CA
92887-4607
US

V. Phone/Fax

Practice location:
  • Phone: 714-900-3067
  • Fax:
Mailing address:
  • Phone: 714-900-3067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: