Individual
ITASCA THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2497 HIGHLAND RD, ARDMORE, OK 73401
(972) 639-2483
Mailing address
PO BOX 116335, CARROLLTON, TX 75011-6335
(972) 537-6868
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/02/2022
Last updated
02/02/2022
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