Provider Demographics
NPI:1376169128
Name:THORNHILL, JODI
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:THORNHILL
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 1:900 CAMEL DR. STE. GG
Mailing Address - Street 2:PMB #154
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4974
Mailing Address - Country:US
Mailing Address - Phone:605-381-7639
Mailing Address - Fax:
Practice Address - Street 1:900 CAMEL DR. STE. GG
Practice Address - Street 2:PMB #154
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4974
Practice Address - Country:US
Practice Address - Phone:605-381-7639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services