Provider Demographics
NPI:1831893981
Name:THORNBERRY, IRIS
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:THORNBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ISAAC
Other - Middle Name:
Other - Last Name:THORNBERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7935 W 98TH PL
Mailing Address - Street 2:
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-2316
Mailing Address - Country:US
Mailing Address - Phone:708-983-4002
Mailing Address - Fax:
Practice Address - Street 1:5540 W 111TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5574
Practice Address - Country:US
Practice Address - Phone:708-634-0821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician