Provider Demographics
NPI:1154626034
Name:THOMPSON, ANN M (LPC, CSAC, ICS)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC, CSAC, ICS
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:M
Other - Last Name:GRIZZLE-THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, SAC
Mailing Address - Street 1:1532 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2514
Mailing Address - Country:US
Mailing Address - Phone:715-297-0564
Mailing Address - Fax:715-845-1977
Practice Address - Street 1:1532 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2514
Practice Address - Country:US
Practice Address - Phone:715-297-0564
Practice Address - Fax:715-845-1977
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15470-131101YA0400X
WI4920-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4920-125OtherSTATE LICENSE
WI15470-131OtherLICENSE