Provider Demographics
NPI:1811743057
Name:THOMPSON, JODI JEAN (LPC)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:JEAN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40438 296TH ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:SD
Mailing Address - Zip Code:57315-5000
Mailing Address - Country:US
Mailing Address - Phone:605-595-8929
Mailing Address - Fax:
Practice Address - Street 1:513 3RD ST SW
Practice Address - Street 2:
Practice Address - City:WAGNER
Practice Address - State:SD
Practice Address - Zip Code:57380-9675
Practice Address - Country:US
Practice Address - Phone:605-384-3418
Practice Address - Fax:605-384-5240
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC20615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health