Provider Demographics
NPI:1942037916
Name:THOMPSON, JANNA
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:
Other - Last Name:CORBY-POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8814 E PARKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-9482
Mailing Address - Country:US
Mailing Address - Phone:951-965-9894
Mailing Address - Fax:
Practice Address - Street 1:316 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2936
Practice Address - Country:US
Practice Address - Phone:208-883-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMFTI-10655106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist