| Doctor Name: | JACQUELYN KAY THOMPSON |
| NPI Number: | 1124187935 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD. , LP., MSE |
| License Number: | LP2495 |
| Business Practice Address: | 1920 Orchard Ln White Bear Lake, MN - 551105330 |
| Business Phone Number: | 6513388702 |
| Business Fax Number: | 6517773692 |
| Mailing Address: | 1920 Orchard Ln, WHITE BEAR LAKE |
| State: | MN |
| Postal Code: | 551105330 |
| Phone Number: | 6513388702 |
| Fax Number: | 6517773692 |
| NPI Enumeration Date: | 12/07/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | LP2495 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |