Healthcare Provider Details

I. General information

NPI: 1962324228
Provider Name (Legal Business Name): ALLY G THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 BURNS AVE
LAKE WALES FL
33853-3314
US

IV. Provider business mailing address

1020 EDGEWATER DR
WINTER HAVEN FL
33884-3008
US

V. Phone/Fax

Practice location:
  • Phone: 863-662-9278
  • Fax:
Mailing address:
  • Phone: 863-662-9278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI8097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: