Provider Demographics
NPI:1487832937
Name:THOMPSON, DUANE HUGH (MA, LP)
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:HUGH
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 15TH STREET NW
Mailing Address - Street 2:SUITE F
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:763-560-4860
Mailing Address - Fax:763-503-1430
Practice Address - Street 1:2475 15TH ST NW
Practice Address - Street 2:SUITE F
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-5605
Practice Address - Country:US
Practice Address - Phone:763-560-4860
Practice Address - Fax:763-503-1430
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1424103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist