MEDICARE: GLENDA THORNE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	692	LA

General Provider Information

NPI Number	:	1932361490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDA THORNE PH.D.

Provider Business Mailing Address
First Line	:	312 S JEFFERSON AVE STE B
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-3169
Country	:	US
Telephone Number	:	985-246-9508
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 S JEFFERSON AVE STE B
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-3169
Country	:	US
Telephone Number	:	985-246-9508
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	04/02/2012

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