Provider Demographics
NPI:1417030933
Name:THOMPSON, LINDA KAY (CSW PIP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CSW PIP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:KAY
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2920 SHERIDAN LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-5350
Mailing Address - Country:US
Mailing Address - Phone:605-348-0477
Mailing Address - Fax:605-348-0479
Practice Address - Street 1:2920 SHERIDAN LAKE ROAD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-5350
Practice Address - Country:US
Practice Address - Phone:605-348-0477
Practice Address - Fax:605-348-0479
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCSW PIP 1093104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6571000Medicaid
SD6571000Medicaid