1619050606 NPI number — MS. JANE LYNN THOMPSON MSW LICSW

Table of content: MS. JANE LYNN THOMPSON MSW LICSW (NPI 1619050606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619050606 NPI number — MS. JANE LYNN THOMPSON MSW LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
JANE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHLUETER
Provider Other First Name:
JANE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619050606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11000 PRAIRIE LAKES DR
Provider Second Line Business Mailing Address:
SUITE 610
Provider Business Mailing Address City Name:
EDEN PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55344-3887
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-991-4019
Provider Business Mailing Address Fax Number:
952-942-5141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11000 PRAIRIE LAKES DR
Provider Second Line Business Practice Location Address:
SUITE 610
Provider Business Practice Location Address City Name:
EDEN PRAIRIE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55344-3887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-991-4019
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  LICSW00630 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6269233 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 209MIED . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".