MEDICARE: LEAH THOMPSON MA, LPC-IT

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	101YP2500X	Professional Counselor	6409

General Provider Information

NPI Number	:	1982982559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH THOMPSON MA, LPC-IT

Provider Business Mailing Address
First Line	:	2701 INTERNATIONAL LN STE 205
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-3126
Country	:	US
Telephone Number	:	608-390-3535
Fax Number	:	608-390-3535

Provider Business Practice Location Address
First Line	:	2701 INTERNATIONAL LN STE 205
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-3126
Country	:	US
Telephone Number	:	608-390-3535
Fax Number	:

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

Provider Enumeration Date	:	07/29/2011
Last Update Date	:	06/15/2022

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