Provider Demographics
NPI:1821619404
Name:THOMAS, JESSALYN
Entity Type:Individual
Prefix:
First Name:JESSALYN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSALYN
Other - Middle Name:
Other - Last Name:ABT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:ND
Mailing Address - Zip Code:58730-3105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:ND
Practice Address - Zip Code:58730-3105
Practice Address - Country:US
Practice Address - Phone:701-965-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker