Provider Demographics
NPI:1851990386
Name:THORN, BRIGITTE A
Entity Type:Individual
Prefix:MRS
First Name:BRIGITTE
Middle Name:A
Last Name:THORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 PINE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-3020
Mailing Address - Country:US
Mailing Address - Phone:573-701-3924
Mailing Address - Fax:
Practice Address - Street 1:607 VIVIAN CT
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-4441
Practice Address - Country:US
Practice Address - Phone:573-701-3924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician