Provider Demographics
NPI:1821116153
Name:THORNER, NANCY (MA, CCC)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:THORNER
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24322 RED BLAZE DR
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-2261
Mailing Address - Country:US
Mailing Address - Phone:301-368-9193
Mailing Address - Fax:301-368-9194
Practice Address - Street 1:24322 RED BLAZE DR
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-2261
Practice Address - Country:US
Practice Address - Phone:301-368-9193
Practice Address - Fax:301-368-9194
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04109235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist