MEDICARE: JERUSHA DOVE THOMPSON PPC

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	101YP2500X	Professional Counselor	PPC-1152	WY

General Provider Information

NPI Number	:	1104419076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERUSHA DOVE THOMPSON PPC

Provider Business Mailing Address
First Line	:	1471 DEWAR DR STE 232
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-5885
Country	:	US
Telephone Number	:	307-352-9161
Fax Number	:

Provider Business Practice Location Address
First Line	:	1471 DEWAR DR STE 232
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-5885
Country	:	US
Telephone Number	:	307-352-9161
Fax Number	:

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

Provider Enumeration Date	:	02/11/2021
Last Update Date	:	04/13/2023

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Directions to “ JERUSHA DOVE THOMPSON PPC” Practice Location

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