Provider Demographics
NPI:1174857288
Name:THORNE, JOHN C (PHC, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:THORNE
Suffix:
Gender:M
Credentials:PHC, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 PORTAGE BAY PL E
Mailing Address - Street 2:HOUSEBOAT A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3886
Mailing Address - Country:US
Mailing Address - Phone:206-940-5792
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:CENTER ON HUMAN DEVELOPMENT & DISABILITY
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-543-7701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60084988235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist