Provider Demographics
NPI:1689004426
Name:THOMPSON, KRISTINA M (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MSW, LICSW
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 383
Mailing Address - Street 2:
Mailing Address - City:FREDERIC
Mailing Address - State:WI
Mailing Address - Zip Code:54837-0383
Mailing Address - Country:US
Mailing Address - Phone:715-869-6484
Mailing Address - Fax:800-684-2131
Practice Address - Street 1:107 HOPE ROAD WEST
Practice Address - Street 2:
Practice Address - City:FREDERIC
Practice Address - State:WI
Practice Address - Zip Code:54837-0383
Practice Address - Country:US
Practice Address - Phone:715-869-6484
Practice Address - Fax:800-684-2131
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI82871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1689004426Medicaid