Healthcare Provider Details

I. General information

NPI: 1417820325
Provider Name (Legal Business Name): DR. JENNIFER ALEXIS THAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 10/24/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HARGER RD STE 600
OAK BROOK IL
60523-1820
US

IV. Provider business mailing address

913 69TH ST
DARIEN IL
60561-3862
US

V. Phone/Fax

Practice location:
  • Phone: 630-571-5750
  • Fax: 630-571-5751
Mailing address:
  • Phone: 630-571-5750
  • Fax: 630-571-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.01148
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: