Healthcare Provider Details

I. General information

NPI: 1114335791
Provider Name (Legal Business Name): WENDY N THORNE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 PENDER DR STE 140
FAIRFAX VA
22030-0986
US

IV. Provider business mailing address

1320 OLD CHAIN BRIDGE RD STE 185
MC LEAN VA
22101-3945
US

V. Phone/Fax

Practice location:
  • Phone: 571-432-0640
  • Fax: 571-407-5266
Mailing address:
  • Phone: 703-942-8110
  • Fax: 703-942-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2101002045
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001514
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: