Provider Demographics
NPI:1639647837
Name:THALHAMER, JESSICA GRACE (DC, LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:GRACE
Last Name:THALHAMER
Suffix:
Gender:F
Credentials:DC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 UNIVERSITY PLZ STE 100
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6210
Mailing Address - Country:US
Mailing Address - Phone:631-834-8647
Mailing Address - Fax:
Practice Address - Street 1:2 UNIVERSITY PLZ STE 100
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6210
Practice Address - Country:US
Practice Address - Phone:631-834-8647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2025-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0971161041C0700X
NV12313-C1041C0700X
CT143341041C0700X
NJ44SC064239001041C0700X
MELC240341041C0700X
NY013113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No111N00000XChiropractic ProvidersChiropractor