Provider Demographics
NPI:1245807585
Name:THORNOCK, RONADEE MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:RONADEE
Middle Name:MARIE
Last Name:THORNOCK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 DICKSON CIR E
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-3865
Mailing Address - Country:US
Mailing Address - Phone:120-824-3665
Mailing Address - Fax:
Practice Address - Street 1:2300 N YELLOWSTONE HWY STE 207
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-1652
Practice Address - Country:US
Practice Address - Phone:801-719-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-40738101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health