Provider Demographics
NPI:1679125348
Name:THOMPSON, JILLIAN PEARL
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:PEARL
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5089 BATESON DR NE
Mailing Address - Street 2:
Mailing Address - City:THORNVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43076-9259
Mailing Address - Country:US
Mailing Address - Phone:740-823-3650
Mailing Address - Fax:
Practice Address - Street 1:5089 BATESON DR NE
Practice Address - Street 2:
Practice Address - City:THORNVILLE
Practice Address - State:OH
Practice Address - Zip Code:43076-9259
Practice Address - Country:US
Practice Address - Phone:740-823-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH06021982Medicaid