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General NPI Number Information
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NPI Number | 1609945062
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Entity Type | Individual
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Provider Name | MARY R. THOMPSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 217 E. SANILAC SUITE ONE
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City | SANDUSKY
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State | MI
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Zip | 48471
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Country | US
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Telephone | 810-648-4450
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Fax | 810-648-5833
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Provider Business Mailing Address
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Address Line | 6216 KILGOUR ST
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City | MARLETTE
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State | MI
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Zip | 48453-1363
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Country | US
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Telephone | 989-635-2168
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801059681
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License Number State | MI
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