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NPI Code Detail

MEDICARE: JENNIFER MARIE THOMASON LCPC

MEDICARE: JENNIFER MARIE THOMASON LCPC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1083754931
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MARIE THOMASON LCPC
Provider Business Mailing Address
First Line : 5259 S MILL POND RD
Second Line :
City : ROCHELLE
State : IL
Zip : 61068-9136
Country : US
Telephone Number : 815-562-9509
Fax Number :
Provider Business Practice Location Address
First Line : 125 S 4TH ST
Second Line :
City : OREGON
State : IL
Zip : 61061-1609
Country : US
Telephone Number : 815-732-3157
Fax Number : 815-732-3834
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2007
Last Update Date : 03/18/2012

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Directions to “ JENNIFER MARIE THOMASON LCPC” Practice Location

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