Basic Information
| Provider Information | |||||||||
| NPI: | 1447473681 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | KAYE | ||||||||
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| Credential: | LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7225 HEMLOCK LN N APT 324 | ||||||||
| Address2: | |||||||||
| City: | MAPLE GROVE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553695527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7014514900 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 19021 FREEPORT ST NW STE 500 | ||||||||
| Address2: | |||||||||
| City: | ELK RIVER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553301278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7014413951 | ||||||||
| FaxNumber: | 7014418661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 103T00000X | LP 3412 | MN | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 657T3TH | 01 | MN | BCBS MN | OTHER | HP58818 | 01 | MS | HEALTH PARTNERS | OTHER | 26473 | 01 | ND | BCBS ND | OTHER | 55330-A009 | 01 | MN | TRI WEST | OTHER | 62-50613 | 01 | MN | MEDICA UBH | OTHER | 990991046384 | 01 | MN | BHP PREFERRED 1 | OTHER | 138231 | 01 | MN | U CARE | OTHER | 2085750 | 01 | MN | CIGNA | OTHER |