Healthcare Provider Details

I. General information

NPI: 1083125975
Provider Name (Legal Business Name): MARISOL THOMPSON CL60166800
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARISOL THOMPSON

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 S 11TH ST
TACOMA WA
98405-3332
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 253-280-9836
  • Fax: 253-280-9853
Mailing address:
  • Phone: 206-764-0502
  • Fax: 206-764-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCL60166800
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCL60166800
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: