Provider Demographics
NPI:1306300173
Name:THOMPSON, DELLA J (MA ED)
Entity type:Individual
Prefix:
First Name:DELLA
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA ED
Other - Prefix:
Other - First Name:DELLA
Other - Middle Name:J
Other - Last Name:TEDDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4745 E 174TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-3923
Mailing Address - Country:US
Mailing Address - Phone:216-413-7408
Mailing Address - Fax:
Practice Address - Street 1:4745 E 174TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-3923
Practice Address - Country:US
Practice Address - Phone:216-413-7408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management