Provider Demographics
NPI:1144641366
Name:THOMPSON, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N 52ND ST
Mailing Address - Street 2:APT# 2252
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6734
Mailing Address - Country:US
Mailing Address - Phone:623-565-3282
Mailing Address - Fax:
Practice Address - Street 1:815 N 52ND ST
Practice Address - Street 2:APT# 2252
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6734
Practice Address - Country:US
Practice Address - Phone:623-565-3282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA86572355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant