Provider Demographics
NPI:1104203157
Name:THORSON, JEREMY (BS)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:THORSON
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 W ORCHARD AVE
Mailing Address - Street 2:APARTMENT #D 305
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1992
Mailing Address - Country:US
Mailing Address - Phone:260-312-3288
Mailing Address - Fax:
Practice Address - Street 1:456 WEST ORCHARD AVE.
Practice Address - Street 2:APT D305
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651
Practice Address - Country:US
Practice Address - Phone:260-312-3288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker