Provider Demographics
NPI:1861555187
Name:THORN, SOFIA L (LCSW)
Entity type:Individual
Prefix:MS
First Name:SOFIA
Middle Name:L
Last Name:THORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1452 N 7TH ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-2301
Mailing Address - Country:US
Mailing Address - Phone:414-935-8000
Mailing Address - Fax:414-287-0907
Practice Address - Street 1:1452 N 7TH ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-2301
Practice Address - Country:US
Practice Address - Phone:414-342-2018
Practice Address - Fax:414-287-0907
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7306-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43712200Medicaid
WI001884930Medicare ID - Type Unspecified