Provider Demographics
NPI:1902364003
Name:JUDY THORNTON MSW PLLC
Entity Type:Organization
Organization Name:JUDY THORNTON MSW PLLC
Other - Org Name:JUDY THORNTON, MSW
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:509-747-7147
Mailing Address - Street 1:10720 E 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5586
Mailing Address - Country:US
Mailing Address - Phone:509-979-7922
Mailing Address - Fax:509-323-1607
Practice Address - Street 1:1303 W MAXWELL AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2714
Practice Address - Country:US
Practice Address - Phone:509-747-7147
Practice Address - Fax:509-323-1607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2106599Medicaid