Individual
JAKE G THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSS-MH
Contact information
Practice address
640 NE 3RD ST, MCMINNVILLE, OR 97128-4630
(503) 474-5509
Mailing address
640 NE 3RD ST, MCMINNVILLE, OR 97128-4630
(503) 474-5509
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105853
TRADITIONAL HEALTH WORKER
OR
Enumeration date
12/07/2021
Last updated
12/07/2021
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