Provider Demographics
NPI:1053606251
Name:THOMPSON, GRETCHEN P (LISW)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:P
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6031
Mailing Address - Country:US
Mailing Address - Phone:563-542-6595
Mailing Address - Fax:
Practice Address - Street 1:1340 BLAIRS FERRY RD
Practice Address - Street 2:UNIT A
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-1900
Practice Address - Country:US
Practice Address - Phone:319-398-6694
Practice Address - Fax:319-369-4673
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA008771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical