Provider Demographics
NPI:1558074617
Name:THORNE, SIDNEY BALES (MSWI SUDC)
Entity Type:Individual
Prefix:MS
First Name:SIDNEY
Middle Name:BALES
Last Name:THORNE
Suffix:
Gender:F
Credentials:MSWI SUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8462 S 4670 W
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-4799
Mailing Address - Country:US
Mailing Address - Phone:801-574-8833
Mailing Address - Fax:
Practice Address - Street 1:879 S OREM BLVD STE 1
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5030
Practice Address - Country:US
Practice Address - Phone:801-802-8608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical