MEDICARE: GAGE 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	175T00000X	Peer Specialist	APS.006439	OH
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1841139755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAGE THOMPSON

Provider Business Mailing Address
First Line	:	1939 SUTTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-1655
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4969 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3907
Country	:	US
Telephone Number	:	513-801-0573
Fax Number	:

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

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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Directions to “ GAGE THOMPSON ” Practice Location

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