Provider Demographics
NPI:1922293588
Name:THORNBURG, BRIGITTE DEANNE
Entity Type:Individual
Prefix:MRS
First Name:BRIGITTE
Middle Name:DEANNE
Last Name:THORNBURG
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 1:555 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-2310
Mailing Address - Country:US
Mailing Address - Phone:815-561-9003
Mailing Address - Fax:
Practice Address - Street 1:555 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-2310
Practice Address - Country:US
Practice Address - Phone:815-561-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health