Provider Demographics
NPI:1851541635
Name:THELEN, ILENE M (M ED)
Entity Type:Individual
Prefix:MRS
First Name:ILENE
Middle Name:M
Last Name:THELEN
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:ILENE
Other - Middle Name:M
Other - Last Name:ROSENBLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M ED
Mailing Address - Street 1:11540 W COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11540 W COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4253
Practice Address - Country:US
Practice Address - Phone:623-533-7794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool