Provider Demographics
NPI:1417820325
Name:THAL, JENNIFER ALEXIS
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ALEXIS
Last Name:THAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 69TH ST
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-3862
Mailing Address - Country:US
Mailing Address - Phone:630-571-5750
Mailing Address - Fax:630-571-5751
Practice Address - Street 1:1200 HARGER RD STE 600
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1820
Practice Address - Country:US
Practice Address - Phone:630-571-5750
Practice Address - Fax:630-571-5751
Is Sole Proprietor?:No
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.01148103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical