Provider Demographics
NPI:1467299289
Name:THORNE, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:THORNE
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 1:854 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-5111
Mailing Address - Country:US
Mailing Address - Phone:507-474-2197
Mailing Address - Fax:
Practice Address - Street 1:445 BROADWAY AVE STE A
Practice Address - Street 2:
Practice Address - City:SAINT PAUL PARK
Practice Address - State:MN
Practice Address - Zip Code:55071-1554
Practice Address - Country:US
Practice Address - Phone:612-242-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist