1144327107 NPI number — MRS. PATRICIA M THORN KISH LCSW

Table of content: MRS. PATRICIA M THORN KISH LCSW (NPI 1144327107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144327107 NPI number — MRS. PATRICIA M THORN KISH LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORN KISH
Provider First Name:
PATRICIA
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THORN
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144327107
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2493 GALA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST LAFAYETTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47906-4839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-414-8227
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 SAW MILL RD
Provider Second Line Business Practice Location Address:
STE 3103
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47905-5592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-414-8227
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  34003983 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com