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General NPI Number Information
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NPI Number | 1245807585
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Entity Type | Individual
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Provider Name | RONADEE MARIE THORNOCK LMSW
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Gender | Female
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 2300 N YELLOWSTONE HWY STE 207
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City | IDAHO FALLS
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State | ID
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Zip | 83401-1652
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Country | US
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Telephone | 801-719-7737
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Fax |
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Provider Business Mailing Address
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Address Line | 2218 DICKSON CIR E
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3865
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Country | US
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Telephone | 120-824-3665
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMSW-40738
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License Number State | ID
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