Healthcare Provider Details

I. General information

NPI: 1124398490
Provider Name (Legal Business Name): SARAH W THOMPSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MAIN ST SUITE 200
VANCOUVER WA
98660-3402
US

IV. Provider business mailing address

601 MAIN ST SUITE 200
VANCOUVER WA
98660-3402
US

V. Phone/Fax

Practice location:
  • Phone: 402-730-2408
  • Fax: 888-972-1811
Mailing address:
  • Phone: 402-730-2408
  • Fax: 888-972-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY 60509055
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: