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NPI Code Detail

MEDICARE: MRS. MARJORE IRENE THOMPSON LICSW

MEDICARE: MRS. MARJORE IRENE THOMPSON LICSW
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
11041C0700XClinical Social Worker07188MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14T865THOTHERMNBHSI
261-15833OTHERMNMEDICA (ST.,CHOICE)
3107922-0001OTHERMNUCARE PCP
4107922OTHERMNUCARE
5HP11602OTHERMNHEALTH PARTNERS
61008615OTHERMNPREFERRED ONE
762-15833OTHERMNUBH
8837697OTHERMNAMERICAS PPO

General Provider Information

NPI Number : 1184694101
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARJORE IRENE THOMPSON LICSW
Provider Business Mailing Address
First Line : 1074 CEDAR VIEW DR
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55405-2129
Country : US
Telephone Number : 612-381-0106
Fax Number :
Provider Business Practice Location Address
First Line : 2001 BLOOMINGTON AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-3074
Country : US
Telephone Number : 612-638-0700
Fax Number : 612-627-4205
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2006
Last Update Date : 07/08/2007

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