Provider Demographics
NPI:1386706208
Name:THOMPSON, JENNIFER KIMBERLY (ATC, LAT, PES)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KIMBERLY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:ATC, LAT, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 S GREENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-7104
Mailing Address - Country:US
Mailing Address - Phone:815-599-6340
Mailing Address - Fax:815-599-6748
Practice Address - Street 1:1010 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6600
Practice Address - Country:US
Practice Address - Phone:815-599-6340
Practice Address - Fax:815-599-6748
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0021922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer