Jacquelyn Kay Thompson, PHD. , LP., MSE

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP2495 Issued in MN

Practice address

1920 Orchard LN
White Bear Lake, MN 55110-5330

Phone

(651) 338-8702

Fax

(651) 777-3692

NPI assigned

Dec 7, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124187935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 ORCHARD LN",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551105330",
            "telephone_number": "651-338-8702",
            "fax_number": "651-777-3692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 ORCHARD LN",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551105330",
            "telephone_number": "651-338-8702",
            "fax_number": "651-777-3692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "JACQUELYN",
        "middle_name": "KAY",
        "credential": "PHD. , LP., MSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP2495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN. HEALTHCARE PROGRAMS",
            "identifier": "6466885300",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVORAL HEALTH",
            "identifier": "6172268",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.