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General NPI Number Information
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NPI Number | 1881794642
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Entity Type | Individual
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Provider Name | PAMELA JEAN THOMPSON LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 415 1/2 NEBRASKA AVE.
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City | BRECKENRIDGE
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State | MN
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Zip | 56520
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Country | US
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Telephone | 218-643-9330
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Fax | 218-643-9330
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Provider Business Mailing Address
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Address Line | 682 WYNDEMERE DR
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City | WEST FARGO
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State | ND
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Zip | 58078-4036
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LICSW 6408
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License Number State | MN
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