Provider Demographics
NPI:1588047526
Name:THOMPSON, ADRIA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ADRIA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 S 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4009
Mailing Address - Country:US
Mailing Address - Phone:606-344-9955
Mailing Address - Fax:
Practice Address - Street 1:603 S 31ST AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4009
Practice Address - Country:US
Practice Address - Phone:606-344-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-2742235Z00000X
KYSLPLPA00218485235Z00000X
KY162888235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist