Healthcare Provider Details

I. General information

NPI: 1851358790
Provider Name (Legal Business Name): JODIE ALENE THOMPSON REGISTER COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 E MEAD AVE
YAKIMA WA
98903-3720
US

IV. Provider business mailing address

190 SAGE COVE RD
YAKIMA WA
98903-9114
US

V. Phone/Fax

Practice location:
  • Phone: 509-453-1344
  • Fax: 509-453-2209
Mailing address:
  • Phone: 509-972-7872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberRC00033464
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: