Provider Demographics
NPI:1194374033
Name:THAKKAR, KINJAL (BS, MHP)
Entity Type:Individual
Prefix:
First Name:KINJAL
Middle Name:
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:BS, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 FOXFORD RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1923
Mailing Address - Country:US
Mailing Address - Phone:630-965-3986
Mailing Address - Fax:
Practice Address - Street 1:1140 N MCLEAN BLVD STE I
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-1782
Practice Address - Country:US
Practice Address - Phone:847-695-3680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health