Healthcare Provider Details

I. General information

NPI: 1518382704
Provider Name (Legal Business Name): KARI THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 N MERCHANT ST
EFFINGHAM IL
62401-2128
US

IV. Provider business mailing address

408 S 4TH ST
EFFINGHAM IL
62401-1226
US

V. Phone/Fax

Practice location:
  • Phone: 217-342-7000
  • Fax: 217-342-7002
Mailing address:
  • Phone: 217-347-5118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.008481
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: