Provider Demographics
NPI:1619413408
Name:THORN, NANCY FAE
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:FAE
Last Name:THORN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:FAE
Other - Last Name:THORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC, SLP
Mailing Address - Street 1:5811 E ITHACA PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1120
Mailing Address - Country:US
Mailing Address - Phone:303-263-4734
Mailing Address - Fax:720-777-9236
Practice Address - Street 1:8401 ARISTA PL
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-4154
Practice Address - Country:US
Practice Address - Phone:720-777-9209
Practice Address - Fax:720-777-9236
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist