Provider Demographics
NPI:1356733091
Name:THOMPSON, JEANNA (CMT, SP, CHT)
Entity type:Individual
Prefix:
First Name:JEANNA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CMT, SP, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:ND
Mailing Address - Zip Code:58341-1521
Mailing Address - Country:US
Mailing Address - Phone:701-341-7652
Mailing Address - Fax:
Practice Address - Street 1:817 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:ND
Practice Address - Zip Code:58341-1521
Practice Address - Country:US
Practice Address - Phone:701-341-7652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1437225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist