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General NPI Number Information
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NPI Number | 1043104326
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Entity Type | Individual
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Provider Name | MADELINE JENNIFER THORN
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Gender | Female
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 4625 S 2300 E
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City | SALT LAKE CITY
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State | UT
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Zip | 84117-4583
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Country | US
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Telephone | 801-865-1453
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Fax |
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Provider Business Mailing Address
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Address Line | 836 E 480 S
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City | AMERICAN FORK
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State | UT
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Zip | 84003-4266
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Country | US
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Telephone | 915-274-2358
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 134591113502
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License Number State | UT
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