Basic Information
| Provider Information | |||||||||
| NPI: | 1144234220 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2758 | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507042758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192355390 | ||||||||
| FaxNumber: | 3192331630 | ||||||||
| Practice Location | |||||||||
| Address1: | 1753 W RIDGEWAY AVE STE 111 | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3198335970 | ||||||||
| FaxNumber: | 3198335971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 09/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 865 | IA | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 231H00000X | 558 | IA | Y | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | 147001127 | IL | N | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 211928 | 01 | IA | IOWA HEALTH SOLUTIONS | OTHER | 0236778 | 05 | IA | MEDICAID | 05573 | 01 | IA | NATIONAL EAR CARE PLAN | OTHER |