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General NPI Number Information
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NPI Number | 1609956390
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Entity Type | Individual
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Provider Name | SALLETTE ANN THOMPSON PSYD
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Gender | Female
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 02/18/2013
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Provider Practice Location Address
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Address Line | 1148 W. BELLA CASA DR.
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City | PUEBLO WEST
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State | CO
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Zip | 81007
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Country | US
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Telephone | 907-590-9468
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Fax | 530-548-7418
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Provider Business Mailing Address
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Address Line | 1148 W. BELLA CASA DR
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City | PUEBLO WEST
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State | CO
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Zip | 81007
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Country | US
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Telephone | 907-590-9468
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Fax | 530-548-7418
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3289
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CO3289
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License Number State | CO
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