Healthcare Provider Details

I. General information

NPI: 1043137169
Provider Name (Legal Business Name): NICHOLAS THOMPSON MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 NW 1ST AVE
GRAND RAPIDS MN
55744-2702
US

IV. Provider business mailing address

217 NW 1ST AVE
GRAND RAPIDS MN
55744-2702
US

V. Phone/Fax

Practice location:
  • Phone: 218-301-7581
  • Fax:
Mailing address:
  • Phone:
  • 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: