MEDICARE: MS. LUANN KAY THOMPSON BSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033342993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LUANN KAY THOMPSON BSW

Provider Business Mailing Address
First Line	:	211 CHANDLER ST
Second Line	:	APT. 312
City	:	CAPE CANAVERAL
State	:	FL
Zip	:	32920-2665
Country	:	US
Telephone Number	:	321-794-3918
Fax Number	:	321-610-8880

Provider Business Practice Location Address
First Line	:	1861 S PATRICK DR
Second Line	:	BOX 166
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-4377
Country	:	US
Telephone Number	:	321-610-8880
Fax Number	:	321-610-8880

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2009
Last Update Date	:	08/26/2009

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