Provider Demographics
NPI:1942073143
Name:THORUP, MCKENNA (MSW)
Entity Type:Individual
Prefix:
First Name:MCKENNA
Middle Name:
Last Name:THORUP
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 S CASE MOUNTAIN CV
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-3996
Mailing Address - Country:US
Mailing Address - Phone:720-215-8617
Mailing Address - Fax:
Practice Address - Street 1:4516 S 700 E STE 275
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8605
Practice Address - Country:US
Practice Address - Phone:801-337-2156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker