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NPI Code Detail

MEDICARE: JACQUELYN RENAE THOMPSON LICSW, LADC

MEDICARE: JACQUELYN RENAE THOMPSON LICSW, LADC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1137NE
2104100000XSocial Worker
31041C0700XClinical Social Worker1336NE
41041C0700XClinical Social Worker1086NE

General Provider Information

NPI Number : 1780879916
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN RENAE THOMPSON LICSW, LADC
Provider Business Mailing Address
First Line : 1941 S 42ND ST STE 328
Second Line :
City : OMAHA
State : NE
Zip : 68105-2943
Country : US
Telephone Number : 402-614-8444
Fax Number :
Provider Business Practice Location Address
First Line : 1941 S 42ND ST STE 328
Second Line :
City : OMAHA
State : NE
Zip : 68105-2943
Country : US
Telephone Number : 402-614-8444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2007
Last Update Date : 01/24/2024

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Directions to “ JACQUELYN RENAE THOMPSON LICSW, LADC” Practice Location

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