Provider Demographics
NPI:1922129543
Name:THRASHER, PENELOPE ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:ANN
Last Name:THRASHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8926B LA CROSSE AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1940
Mailing Address - Country:US
Mailing Address - Phone:847-674-9313
Mailing Address - Fax:
Practice Address - Street 1:66 W OAK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-7325
Practice Address - Country:US
Practice Address - Phone:312-337-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001632038OtherBLUE CROSS BLUE SHIELD
IL480277OtherVALUE OPTIONS
ILS78426Medicare PIN
IL0001632038OtherBLUE CROSS BLUE SHIELD