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General NPI Number Information
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NPI Number | 1285027953
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Entity Type | Individual
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Provider Name | CODI SUE THOMPSON RDN, LD, CLC, CDE
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Gender | Female
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 904 W SUNSET DR
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City | RIVERTON
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State | WY
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Zip | 82501-2307
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Country | US
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Telephone | 307-349-1804
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Fax | 307-851-1465
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Provider Business Mailing Address
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Address Line | PO BOX 1606
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City | RIVERTON
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State | WY
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Zip | 82501-0197
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Country | US
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Telephone | 307-349-1804
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Fax | 307-851-1465
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 032
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License Number State | WY
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