Healthcare Provider Details

I. General information

NPI: 1396665584
Provider Name (Legal Business Name): ANNMARIE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23917 W ROBERT AVE
PLAINFIELD IL
60544-3161
US

IV. Provider business mailing address

1013 LOIS PL APT 303
JOLIET IL
60435-3508
US

V. Phone/Fax

Practice location:
  • Phone: 630-656-2430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: