Healthcare Provider Details

I. General information

NPI: 1063343069
Provider Name (Legal Business Name): JACKIE F THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 INYO ST APT 127
CRESCENT CITY CA
95531-2153
US

IV. Provider business mailing address

1403 INYO ST APT 127
CRESCENT CITY CA
95531-2153
US

V. Phone/Fax

Practice location:
  • Phone: 707-954-5169
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: