Provider Demographics
NPI:1184694101
Name:THOMPSON, MARJORE IRENE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:MARJORE
Middle Name:IRENE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 CEDAR VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2129
Mailing Address - Country:US
Mailing Address - Phone:612-381-0106
Mailing Address - Fax:
Practice Address - Street 1:2001 BLOOMINGTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3074
Practice Address - Country:US
Practice Address - Phone:612-638-0700
Practice Address - Fax:612-627-4205
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN071881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4T865THOtherBHSI
MN61-15833OtherMEDICA (ST.,CHOICE)
MN107922-0001OtherUCARE PCP
MN107922OtherUCARE
MNHP11602OtherHEALTH PARTNERS
MN1008615OtherPREFERRED ONE
MN62-15833OtherUBH
MN837697OtherAMERICAS PPO
MN1008615OtherPREFERRED ONE
MN4T865THOtherBHSI