Provider Demographics
NPI:1386808392
Name:THOMPSON, JOELLYN SMITH (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JOELLYN
Middle Name:SMITH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12423 SHORE LANDS RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2624
Mailing Address - Country:US
Mailing Address - Phone:281-770-8561
Mailing Address - Fax:
Practice Address - Street 1:12423 SHORE LANDS RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-2624
Practice Address - Country:US
Practice Address - Phone:281-770-8561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLSA10645235Z00000X
TX115434235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002788600Medicaid
FL003221400Medicaid
FL002788600Medicaid