Healthcare Provider Details

I. General information

NPI: 1922172667
Provider Name (Legal Business Name): JANE KUCERA THOMPSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S 40TH AVE SUITE 24 EAST SLOPE NEUROPSYCHOLOGY INC
YAKIMA WA
98908-3868
US

IV. Provider business mailing address

1015 S 40TH AVE SUITE 24
YAKIMA WA
98908-3868
US

V. Phone/Fax

Practice location:
  • Phone: 509-966-2961
  • Fax: 509-966-2318
Mailing address:
  • Phone: 509-966-2961
  • Fax: 509-966-2318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY2939
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY2939
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY00002939
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPY00002939
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: