Healthcare Provider Details

I. General information

NPI: 1518688316
Provider Name (Legal Business Name): MICHELLE J THOMPSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14775 N KIMO CT
RATHDRUM ID
83858-8762
US

IV. Provider business mailing address

PO BOX 1185
RATHDRUM ID
83858-1185
US

V. Phone/Fax

Practice location:
  • Phone: 208-687-0538
  • Fax: 208-687-3185
Mailing address:
  • Phone: 208-755-1343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-42656
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: