Individual
JACQUELYN KAY THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD. , LP., MSE
Contact information
Practice address
1920 ORCHARD LN, WHITE BEAR LAKE, MN 55110-5330
(651) 338-8702
(651) 777-3692
Mailing address
1920 ORCHARD LN, WHITE BEAR LAKE, MN 55110-5330
(651) 338-8702
(651) 777-3692
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP2495
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6172268
UNITED BEHAVORAL HEALTH
MN
01
—
6466885300
MN. HEALTHCARE PROGRAMS
MN
Enumeration date
12/07/2006
Last updated
07/08/2007
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