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General NPI Number Information
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NPI Number | 1629563630
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Entity Type | Individual
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Provider Name | LORRAINE BOARDLEY THOMPSON III SLP
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Gender | Female
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 06/22/2018
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Provider Practice Location Address
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Address Line | 436 PROVIDENCE RD
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City | CHESAPEAKE
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State | VA
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Zip | 23325-4603
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Country | US
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Telephone | 757-578-7060
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Fax |
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Provider Business Mailing Address
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Address Line | 605 MILE CREEK LN
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City | CHESAPEAKE
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State | VA
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Zip | 23322-1279
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Country | US
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Telephone | 757-642-7452
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202002648
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License Number State | VA
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