MEDICARE: JOSEPHINE THORMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1902674443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINE THORMAN

Provider Business Mailing Address
First Line	:	13600 COMMERCE BLVD APT 315
Second Line	:
City	:	ROGERS
State	:	MN
Zip	:	55374-4565
Country	:	US
Telephone Number	:	608-295-3486
Fax Number	:

Provider Business Practice Location Address
First Line	:	5637 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-3061
Country	:	US
Telephone Number	:	763-432-3926
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	12/14/2023

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Directions to “ JOSEPHINE THORMAN ” Practice Location

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