Provider Demographics
NPI:1285957449
Name:THOMPSON, JENNIFER LAUREL (CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LAUREL
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8824 SMOKEY DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-4123
Mailing Address - Country:US
Mailing Address - Phone:972-390-8962
Mailing Address - Fax:
Practice Address - Street 1:8824 SMOKEY DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-4123
Practice Address - Country:US
Practice Address - Phone:972-390-8962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist