MEDICARE: MRS. JENNY LOU THOMPSON H.I.S

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	237600000X	Audiologist-Hearing Aid Fitter	2620	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	411947144	OTHER	MN	FEDERAL TAX ID

General Provider Information

NPI Number	:	1508105263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNY LOU THOMPSON H.I.S

Provider Business Mailing Address
First Line	:	45 HICKORY LN
Second Line	:
City	:	WINONA
State	:	MN
Zip	:	55987-6116
Country	:	US
Telephone Number	:	507-410-2154
Fax Number	:

Provider Business Practice Location Address
First Line	:	52 W 3RD ST
Second Line	:
City	:	WINONA
State	:	MN
Zip	:	55987-3431
Country	:	US
Telephone Number	:	507-457-9830
Fax Number	:	507-457-9834

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

Provider Enumeration Date	:	01/31/2013
Last Update Date	:	01/31/2013

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