Individual
RON THOMPSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
4647 E MORNINGSIDE DR, BLOOMINGTON, IN 47408-3167
(812) 333-1160
Mailing address
4647 E MORNINGSIDE DR, BLOOMINGTON, IN 47408-3167
(812) 333-1160
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20090225
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000235775
ANTHEM
IN
Enumeration date
02/13/2006
Last updated
07/08/2007
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