Provider Demographics
NPI:1457686339
Name:THOMSON, JANET LYNN (RRW- 0106)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LYNN
Last Name:THOMSON
Suffix:
Gender:F
Credentials:RRW- 0106
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5643
Mailing Address - Street 2:
Mailing Address - City:CLEARLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95422-5643
Mailing Address - Country:US
Mailing Address - Phone:707-350-7737
Mailing Address - Fax:
Practice Address - Street 1:6885 OLD HWY 53
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422
Practice Address - Country:US
Practice Address - Phone:707-995-3235
Practice Address - Fax:707-995-7004
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARRW-0106101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARRW-0106OtherSUBSTANCE ABUSE DISORDER