Provider Demographics
NPI:1093804130
Name:THORNTON, JUDY (MSW)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10720 E 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5586
Mailing Address - Country:US
Mailing Address - Phone:509-922-7623
Mailing Address - Fax:
Practice Address - Street 1:1303 W MAXWELL AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2714
Practice Address - Country:US
Practice Address - Phone:509-979-7922
Practice Address - Fax:509-747-3828
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00007802104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty