Provider Demographics
NPI:1285944371
Name:THOMPSON, MARY
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
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:PO BOX 1122
Mailing Address - Street 2:
Mailing Address - City:INOLA
Mailing Address - State:OK
Mailing Address - Zip Code:74036-1122
Mailing Address - Country:US
Mailing Address - Phone:918-543-2091
Mailing Address - Fax:
Practice Address - Street 1:510 S ELLIOTT ST
Practice Address - Street 2:SUITE C
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-6421
Practice Address - Country:US
Practice Address - Phone:918-825-4837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty