MEDICARE: EMILY DIANE 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	235Z00000X	Speech-Language Pathologist	200857	AR

General Provider Information

NPI Number	:	1992336929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY DIANE THOMPSON

Provider Business Mailing Address
First Line	:	346 BROWN RD
Second Line	:
City	:	CAVE SPRINGS
State	:	AR
Zip	:	72718-9482
Country	:	US
Telephone Number	:	479-387-0673
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 W 3RD ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-2702
Country	:	US
Telephone Number	:	501-748-9200
Fax Number	:

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

Provider Enumeration Date	:	01/29/2020
Last Update Date	:	01/29/2020

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Directions to “ EMILY DIANE THOMPSON ” Practice Location

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