Healthcare Provider Details

I. General information

NPI: 1508105263
Provider Name (Legal Business Name): JENNY LOU THOMPSON H.I.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNY LOU VERNON-THOMPSON H.I.S

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 W 3RD ST
WINONA MN
55987-3431
US

IV. Provider business mailing address

45 HICKORY LN
WINONA MN
55987-6116
US

V. Phone/Fax

Practice location:
  • Phone: 507-457-9830
  • Fax: 507-457-9834
Mailing address:
  • Phone: 507-410-2154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2620
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: