Provider Demographics
NPI:1104168491
Name:THOMPSON, SOPHIA DEANNE
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:DEANNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 MORGAN AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55430-3455
Mailing Address - Country:US
Mailing Address - Phone:612-760-9110
Mailing Address - Fax:
Practice Address - Street 1:227 COLFAX AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-1402
Practice Address - Country:US
Practice Address - Phone:612-223-0373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker