Provider Demographics
NPI:1437983335
Name:SPOONER THOMPSON, BERNADETTE P (EDS)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:P
Last Name:SPOONER THOMPSON
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S LEXINGTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-2444
Mailing Address - Country:US
Mailing Address - Phone:816-820-3260
Mailing Address - Fax:
Practice Address - Street 1:2716 SE 3RD ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-3428
Practice Address - Country:US
Practice Address - Phone:816-820-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019039866101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional