Provider Demographics
NPI:1679292965
Name:THORNOCK, STEFFANIE
Entity type:Individual
Prefix:
First Name:STEFFANIE
Middle Name:
Last Name:THORNOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 N. 2ND ST.
Mailing Address - Street 2:PO BOX 536
Mailing Address - City:PANACA
Mailing Address - State:NV
Mailing Address - Zip Code:89042
Mailing Address - Country:US
Mailing Address - Phone:435-632-1220
Mailing Address - Fax:
Practice Address - Street 1:321 N. MALL DR. E SUITE 102
Practice Address - Street 2:
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-932-3672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker