Provider Demographics
NPI:1508105263
Name:THOMPSON, JENNY LOU (HIS)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:LOU
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:MRS
Other - First Name:JENNY
Other - Middle Name:LOU
Other - Last Name:VERNON-THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HIS
Mailing Address - Street 1:45 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6116
Mailing Address - Country:US
Mailing Address - Phone:507-410-2154
Mailing Address - Fax:
Practice Address - Street 1:52 W 3RD ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3431
Practice Address - Country:US
Practice Address - Phone:507-457-9830
Practice Address - Fax:507-457-9834
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2620237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN411947144OtherFEDERAL TAX ID