Healthcare Provider Details

I. General information

NPI: 1487517041
Provider Name (Legal Business Name): TAMMY LYNN THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W JEFFERSON ST STE 201
SHOREWOOD IL
60404-3772
US

IV. Provider business mailing address

1913 GLACIER RIDGE DR
PLAINFIELD IL
60586-2828
US

V. Phone/Fax

Practice location:
  • Phone: 630-281-2496
  • Fax:
Mailing address:
  • Phone: 815-272-6275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: