Provider Demographics
NPI:1235678848
Name:THOMPSON, JENNA NICOLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:NICOLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S 11TH AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4835
Mailing Address - Country:US
Mailing Address - Phone:208-239-3815
Mailing Address - Fax:208-239-3814
Practice Address - Street 1:500 S 11TH AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4835
Practice Address - Country:US
Practice Address - Phone:208-239-3815
Practice Address - Fax:208-239-3814
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-380051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical