Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 20809-875 | WI |
N | 103TS0200X | School Psychologist | P0000114 | MI |
NPI | 1073271151 |
---|---|
Provider Name | Robert D Thompson |
First Address | Schofield, WI 54476-5164 |
Second Address | Schofield, WI 54476-5164 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2021 |
Last Update Date | 06/12/2021 |