Provider Demographics
NPI:1770101420
Name:THOMPSON, ALISSA NICHOLE (BSN-RN, PMHNP STUDE)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:NICHOLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:BSN-RN, PMHNP STUDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:2040 W HADDON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3623
Mailing Address - Country:US
Mailing Address - Phone:312-966-5585
Mailing Address - Fax:
Practice Address - Street 1:3976 N AVONDALE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2900
Practice Address - Country:US
Practice Address - Phone:312-966-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041434677163WP0808X
IL209026304363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health