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General NPI Number Information
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NPI Number | 1346127800
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Entity Type | Individual
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Provider Name | MARY THOMPSON
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Gender |
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 1612 WADSWORTH ST
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City | RADFORD
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State | VA
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Zip | 24141-3414
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Country | US
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Telephone | 540-731-3647
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Fax |
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Provider Business Mailing Address
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Address Line | 1612 WADSWORTH ST
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City | RADFORD
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State | VA
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Zip | 24141-3414
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Country | US
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Telephone | 540-731-3647
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Fax |
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | PPS-541847
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License Number State | VA
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