Provider Demographics
NPI:1033785977
Name:TALKSPACE
Entity Type:Organization
Organization Name:TALKSPACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NETWORK CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC, PEL
Authorized Official - Phone:815-955-4012
Mailing Address - Street 1:11625 S DECATHALON LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-6144
Mailing Address - Country:US
Mailing Address - Phone:815-955-4012
Mailing Address - Fax:
Practice Address - Street 1:11625 S DECATHALON LN
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-6144
Practice Address - Country:US
Practice Address - Phone:815-955-4012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty