MEDICARE: LISA THOMPSON

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	1041C0700X	Clinical Social Worker	2942	MN
2	1041C0700X	Clinical Social Worker	8381-123	WI

General Provider Information

NPI Number	:	1194192401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA THOMPSON

Provider Business Mailing Address
First Line	:	PO BOX 817
Second Line	:
City	:	OSCEOLA
State	:	WI
Zip	:	54020-0817
Country	:	US
Telephone Number	:	715-220-1942
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 N MAIN ST STE 101B
Second Line	:
City	:	RIVER FALLS
State	:	WI
Zip	:	54022-3605
Country	:	US
Telephone Number	:	715-417-3241
Fax Number	:	715-417-3243

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

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	03/16/2021

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Directions to “ LISA THOMPSON ” Practice Location

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