MEDICARE: JILLANA VESSEL-THOMPSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	4808	LA
2	1041S0200X	School Social Worker	4808	LA

General Provider Information

NPI Number	:	1063797074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLANA VESSEL-THOMPSON LCSW

Provider Business Mailing Address
First Line	:	2439 MANHATTAN BLVD STE 503A
Second Line	:
City	:	HARVEY
State	:	LA
Zip	:	70058-5328
Country	:	US
Telephone Number	:	504-434-0017
Fax Number	:	504-341-1442

Provider Business Practice Location Address
First Line	:	2439 MANHATTAN BLVD STE 503A
Second Line	:
City	:	HARVEY
State	:	LA
Zip	:	70058-5328
Country	:	US
Telephone Number	:	504-434-0017
Fax Number	:	504-341-1442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2011
Last Update Date	:	12/27/2023

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