Provider Demographics
NPI:1265208425
Name:JESSICA THRALL PLLC
Entity type:Organization
Organization Name:JESSICA THRALL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:THRALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-250-1994
Mailing Address - Street 1:355 W DUNDEE RD STE 214
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-3500
Mailing Address - Country:US
Mailing Address - Phone:847-250-1994
Mailing Address - Fax:
Practice Address - Street 1:1202 E PADDOCK DR
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-4154
Practice Address - Country:US
Practice Address - Phone:773-507-5308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty