Provider Demographics
NPI:1922172667
Name:THOMPSON, JANE KUCERA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:KUCERA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1015 S 40TH AVE
Mailing Address - Street 2:SUITE 24
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3868
Mailing Address - Country:US
Mailing Address - Phone:509-966-2961
Mailing Address - Fax:509-966-2318
Practice Address - Street 1:1015 S 40TH AVE SUITE 24
Practice Address - Street 2:EAST SLOPE NEUROPSYCHOLOGY INC
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3868
Practice Address - Country:US
Practice Address - Phone:509-966-2961
Practice Address - Fax:509-966-2318
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2939103G00000X, 103T00000X
103TR0400X
WAPY00002939103TC0700X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA200926665OtherFED ID