MEDICARE: THOMPSON EARLY LANGUAGE AND AUTISM INTERVENTION, LLC

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1992156939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMPSON EARLY LANGUAGE AND AUTISM INTERVENTION, LLC

Provider Business Mailing Address
First Line	:	PO BOX 114
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-0016
Country	:	US
Telephone Number	:	319-382-2807
Fax Number	:

Provider Business Practice Location Address
First Line	:	7521 POPLAR LN
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-9438
Country	:	US
Telephone Number	:	319-382-2807
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGAUGE PATHOLOGIST
Name	:	MICHELLE YVETTE THOMPSON
Credential	:	M.A., CCC-SLP
Telephone Number	:	319-382-2807

Provider Enumeration Date	:	06/30/2016
Last Update Date	:	01/31/2017

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