MEDICARE: DOROTHY J THOMPSON CSAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	15377-132	WI

General Provider Information

NPI Number	:	1366673196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTHY J THOMPSON CSAC

Provider Business Mailing Address
First Line	:	6400 INDUSTRIAL LOOP
Second Line	:
City	:	GREENDALE
State	:	WI
Zip	:	53129-2452
Country	:	US
Telephone Number	:	414-423-4100
Fax Number	:	414-423-4134

Provider Business Practice Location Address
First Line	:	2821 N 4TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2362
Country	:	US
Telephone Number	:	414-264-4217
Fax Number	:	414-264-4218

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

Provider Enumeration Date	:	07/28/2009
Last Update Date	:	01/11/2026

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