Provider Demographics
NPI:1861160699
Name:THOMPSON SANDERS, DEVYN L (LISW)
Entity type:Individual
Prefix:
First Name:DEVYN
Middle Name:L
Last Name:THOMPSON SANDERS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:DEVNY
Other - Middle Name:L
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:1501 MADISON RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1706
Mailing Address - Country:US
Mailing Address - Phone:513-354-5200
Mailing Address - Fax:
Practice Address - Street 1:1251 NILLES RD STE 5
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-7205
Practice Address - Country:US
Practice Address - Phone:888-830-0347
Practice Address - Fax:513-939-0310
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2207693104100000X
OHI.24061451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker