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General NPI Number Information
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NPI Number | 1942381140
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Entity Type | Individual
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Provider Name | STACEY ANN THORN LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 12/03/2010
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Provider Practice Location Address
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Address Line | 2300 N. CHILDREN'S PLAZA, BOX 10 CHILDREN'S MEMORIAL HOSPITAL
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City | CHICAGO
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State | IL
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Zip | 60614-3363
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Country | US
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Telephone | 773-880-4104
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Fax | 773-880-8109
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Provider Business Mailing Address
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Address Line | 4255 N WHIPPLE ST APT 3
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City | CHICAGO
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State | IL
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Zip | 60618-2515
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Country | US
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Telephone | 312-493-1518
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149011211
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License Number State | IL
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