Provider Demographics
NPI:1275179319
Name:THAYER, AUDREY RENEE (LMSW)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:RENEE
Last Name:THAYER
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 1:927 N 2ND ST STE B
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-3750
Mailing Address - Country:US
Mailing Address - Phone:563-212-3270
Mailing Address - Fax:
Practice Address - Street 1:1421 S BLUFF BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-6551
Practice Address - Country:US
Practice Address - Phone:563-243-0486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor