Individual
KELLY L THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LSW
Contact information
Practice address
1050 WISHARD BLVD, INFECTIOUS DISEASE CLINIC, INDIANAPOLIS, IN 46202-2872
(317) 630-6612
(317) 656-4035
Mailing address
1050 WISHARD BLVD, INFECTIOUS DISEASE CLINIC, INDIANAPOLIS, IN 46202-2872
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
33005328A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200542360
—
IN
Enumeration date
04/22/2008
Last updated
04/22/2008
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