Provider Demographics
NPI:1407072184
Name:THORPE, COLLEEN J (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:J
Last Name:THORPE
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:J
Other - Last Name:GAGLIARDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND LAC
Mailing Address - Street 1:510 ORIENT ST.
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-1631
Mailing Address - Country:US
Mailing Address - Phone:585-866-9025
Mailing Address - Fax:406-233-6046
Practice Address - Street 1:510 ORIENT ST.
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1631
Practice Address - Country:US
Practice Address - Phone:585-866-9025
Practice Address - Fax:406-233-6046
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0084175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath