Provider Demographics
NPI:1396055224
Name:THOMPSON, SHARON L (SAC-IT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:SAC-IT
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 248
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-0248
Mailing Address - Country:US
Mailing Address - Phone:608-372-5813
Mailing Address - Fax:608-372-0889
Practice Address - Street 1:27374 STATE HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-4501
Practice Address - Country:US
Practice Address - Phone:608-372-5813
Practice Address - Fax:608-372-0889
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15347-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)