Provider Demographics
NPI:1033848924
Name:THOMPSON, JESSICA HARLEY
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:HARLEY
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 1:1635 W BELMONT AVE APT 518
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3057
Mailing Address - Country:US
Mailing Address - Phone:954-798-6871
Mailing Address - Fax:
Practice Address - Street 1:3354 N PAULINA ST STE 205
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1087
Practice Address - Country:US
Practice Address - Phone:773-273-9719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health