1467965418 NPI number — MR. JEFFREY WILLIAM THOMPSON MSW CSW

Table of content: MR. JEFFREY WILLIAM THOMPSON MSW CSW (NPI 1467965418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467965418 NPI number — MR. JEFFREY WILLIAM THOMPSON MSW CSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
JEFFREY
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW CSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON
Provider Other First Name:
JEFFREY
Provider Other Middle Name:
WILLIAM
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW CSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1467965418
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
167 LEOTA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48327-3631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-310-7081
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
167 LEOTA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48327-3631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-310-7081
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2017

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: 103TC2200X , with the licence number:  6801063750 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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