Provider Demographics
NPI:1235571928
Name:THOMPSON, JENNIFER LEE (LISW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:UNGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4725 MERLE HAY RD STE 106
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1983
Mailing Address - Country:US
Mailing Address - Phone:515-214-1241
Mailing Address - Fax:844-270-5729
Practice Address - Street 1:4725 MERLE HAY RD STE 106
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-1983
Practice Address - Country:US
Practice Address - Phone:515-214-1241
Practice Address - Fax:844-270-5729
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0082551041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical