Provider Demographics
NPI:1619050606
Name:THOMPSON, JANE LYNN (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:LYNN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:LYNN
Other - Last Name:SCHLUETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:11000 PRAIRIE LAKES DR
Mailing Address - Street 2:SUITE 610
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3887
Mailing Address - Country:US
Mailing Address - Phone:612-991-4019
Mailing Address - Fax:952-942-5141
Practice Address - Street 1:11000 PRAIRIE LAKES DR
Practice Address - Street 2:SUITE 610
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3887
Practice Address - Country:US
Practice Address - Phone:612-991-4019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLICSW00630104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
6269233OtherMEDICA
MN209MIEDOtherBLUE CROSS BLUE SHIELD