Provider Demographics
NPI:1447473681
Name:THOMPSON, LINDA KAYE (LP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:KAYE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7225 HEMLOCK LN N APT 324
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-5527
Mailing Address - Country:US
Mailing Address - Phone:701-451-4900
Mailing Address - Fax:
Practice Address - Street 1:19021 FREEPORT ST NW STE 500
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1278
Practice Address - Country:US
Practice Address - Phone:701-441-3951
Practice Address - Fax:701-441-8661
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 3412103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN657T3THOtherBCBS MN
MSHP58818OtherHEALTH PARTNERS
ND26473OtherBCBS ND
MN55330-A009OtherTRI WEST
MN62-50613OtherMEDICA UBH
MN990991046384OtherBHP PREFERRED 1
MN138231OtherU CARE
MN2085750OtherCIGNA