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General NPI Number Information
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NPI Number | 1265208425
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Entity Type | Organization
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Legal Business Name | JESSICA THRALL PLLC
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Dates
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Enumeration Date | 11/29/2023
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 1202 E PADDOCK DR
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City | PALATINE
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State | IL
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Zip | 60074-4154
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Country | US
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Telephone | 773-507-5308
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Fax |
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Provider Business Mailing Address
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Address Line | 355 W DUNDEE RD STE 214
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-3500
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Country | US
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Telephone | 847-250-1994
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | JESSICA THRALL
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Credential | LCSW
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Telephone | 847-250-1994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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