Provider Demographics
NPI:1124831631
Name:THOMPSON, MICHAEL JAMES
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 S 1000 W
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84119-4106
Mailing Address - Country:US
Mailing Address - Phone:661-515-0515
Mailing Address - Fax:
Practice Address - Street 1:3380 S 1000 W
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84119-4106
Practice Address - Country:US
Practice Address - Phone:661-515-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator