MEDICARE: MRS. JESSICA ANNE THOMPSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	10036433-3502	UT

General Provider Information

NPI Number	:	1013383918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA ANNE THOMPSON

Provider Business Mailing Address
First Line	:	6770 S 900 E STE 201
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-5548
Country	:	US
Telephone Number	:	801-305-3171
Fax Number	:

Provider Business Practice Location Address
First Line	:	6770 S 900 E STE 201
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-5548
Country	:	US
Telephone Number	:	801-305-3171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	06/06/2023

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