Provider Demographics
NPI:1942558473
Name:THOMPSON, JENNIFER MAY (LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MAY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12231 CHERRYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7977
Mailing Address - Country:US
Mailing Address - Phone:720-883-5209
Mailing Address - Fax:
Practice Address - Street 1:12231 CHERRYWOOD ST
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7977
Practice Address - Country:US
Practice Address - Phone:720-883-5209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1781171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist