Provider Demographics
NPI:1083639124
Name:THORNE, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:THORNE
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 1:8100 MARTY ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-3737
Mailing Address - Country:US
Mailing Address - Phone:913-220-9502
Mailing Address - Fax:913-273-6739
Practice Address - Street 1:8100 MARTY ST
Practice Address - Street 2:SUITE 107
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-3737
Practice Address - Country:US
Practice Address - Phone:913-220-9502
Practice Address - Fax:913-273-6739
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1214103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical