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General NPI Number Information
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NPI Number | 1740723121
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Entity Type | Individual
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Provider Name | SE'LENA THOMPSON B..A, CDCA
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Gender | Female
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Dates
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Enumeration Date | 12/02/2016
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 919 2ND ST NE
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City | CANTON
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State | OH
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Zip | 44704-1132
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Country | US
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Telephone | 330-454-7917
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Fax |
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Provider Business Mailing Address
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Address Line | 36 WILSON PL NW
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City | NAVARRE
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State | OH
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Zip | 44662-1028
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Country | US
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Telephone | 937-654-2908
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | SR914313
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License Number State | OH
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