Provider Demographics
NPI:1720708985
Name:THORN, MARILYN
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
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 1:69300 PELLEW CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ARLEE
Mailing Address - State:MT
Mailing Address - Zip Code:59821-8005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:69300 PELLEW CREEK LN
Practice Address - Street 2:
Practice Address - City:ARLEE
Practice Address - State:MT
Practice Address - Zip Code:59821-8005
Practice Address - Country:US
Practice Address - Phone:406-529-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC552421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical