Provider Demographics
NPI:1447427687
Name:THINGVOLD, JACQUELINE JAN (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:JAN
Last Name:THINGVOLD
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:JAN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3149 26TH ST S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-7654
Mailing Address - Country:US
Mailing Address - Phone:608-787-5576
Mailing Address - Fax:
Practice Address - Street 1:E7404A COUNTY BB
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-1139
Practice Address - Country:US
Practice Address - Phone:608-637-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1091-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1091-154OtherWISCONSIN SPEECH PATHOLOGIST LICENSE