Provider Demographics
NPI:1376678292
Name:THORNE, JUDITH W (SLP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:W
Last Name:THORNE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:GRIFTON
Mailing Address - State:NC
Mailing Address - Zip Code:28530-0481
Mailing Address - Country:US
Mailing Address - Phone:252-524-5997
Mailing Address - Fax:252-321-6004
Practice Address - Street 1:106 E VICTORIA CT STE D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5708
Practice Address - Country:US
Practice Address - Phone:252-321-6001
Practice Address - Fax:252-321-6004
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3663235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411677Medicaid