Healthcare Provider Details

I. General information

NPI: 1760804264
Provider Name (Legal Business Name): JANA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7597 BRIDGETOWN RD
CINCINNATI OH
45248-2019
US

IV. Provider business mailing address

7597 BRIDGETOWN RD
CINCINNATI OH
45248-2019
US

V. Phone/Fax

Practice location:
  • Phone: 513-941-4999
  • Fax:
Mailing address:
  • Phone: 513-941-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number120074
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: