Healthcare Provider Details

I. General information

NPI: 1942114194
Provider Name (Legal Business Name): MR. WADUD LATEEF THOMPSON SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10243 MENOMINEE DR
CINCINNATI OH
45251-1727
US

IV. Provider business mailing address

10243 MENOMINEE DR
CINCINNATI OH
45251-1727
US

V. Phone/Fax

Practice location:
  • Phone: 513-514-6969
  • Fax:
Mailing address:
  • Phone: 513-514-6969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number602869611124
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: