Healthcare Provider Details

I. General information

NPI: 1720708985
Provider Name (Legal Business Name): MARILYN THORN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69300 PELLEW CREEK LN
ARLEE MT
59821-8005
US

IV. Provider business mailing address

69300 PELLEW CREEK LN
ARLEE MT
59821-8005
US

V. Phone/Fax

Practice location:
  • Phone: 406-529-8622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-SWLC-LIC55242
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: