Provider Demographics
NPI:1700763448
Name:THOMPSON, WENDY JO (LMBT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:JO
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMBT
Mailing Address - Street 1:415 IRMA WOLFE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-8987
Mailing Address - Country:US
Mailing Address - Phone:309-210-6046
Mailing Address - Fax:
Practice Address - Street 1:119 S TRADE ST STE 104
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5774
Practice Address - Country:US
Practice Address - Phone:309-210-2106
Practice Address - Fax:309-210-2106
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19027173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist