Provider Demographics
NPI:1922192772
Name:THOMPSON, ELIZABETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 MASON LN
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-4458
Mailing Address - Country:US
Mailing Address - Phone:847-344-5858
Mailing Address - Fax:847-253-4597
Practice Address - Street 1:841 MASON LN
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-4458
Practice Address - Country:US
Practice Address - Phone:847-344-5858
Practice Address - Fax:847-253-4597
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003390103T00000X, 103TF0200X, 103TC0700X
WI1843103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001673044OtherBLUE CROSS/BLUE SHIELD
IL0001673044OtherBLUE CROSS/BLUE SHIELD