Provider Demographics
NPI:1386292142
Name:THOMPSON, CHRISTEN MARIAH (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:MARIAH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7605 HOLTON RD
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:MI
Mailing Address - Zip Code:49425-9533
Mailing Address - Country:US
Mailing Address - Phone:810-407-0889
Mailing Address - Fax:
Practice Address - Street 1:1000 E TINKHAM AVE
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1568
Practice Address - Country:US
Practice Address - Phone:231-845-6291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7151001798235Z00000X
MI7101007374235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist