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General NPI Number Information
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NPI Number | 1942220892
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Entity Type | Individual
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Provider Name | SUZANNE M THOMPSON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 1 CHILDRENS PL #3N14
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1002
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Country | US
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Telephone | 314-454-6069
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Fax | 314-454-4013
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Provider Business Mailing Address
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Address Line | 1 CHILDRENS PL #3N14
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1002
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Country | US
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Telephone | 314-454-6069
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Fax | 314-454-4013
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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 | PY01772
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License Number State | MO
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