Provider Demographics
NPI:1154601052
Name:THAYER, ALISON (LCPC, CEAP)
Entity type:Individual
Prefix:MS
First Name:ALISON
Middle Name:
Last Name:THAYER
Suffix:
Gender:F
Credentials:LCPC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 N WAIOLA AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-5528
Mailing Address - Country:US
Mailing Address - Phone:312-351-4061
Mailing Address - Fax:
Practice Address - Street 1:512 W BURLINGTON AVE STE 3
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2225
Practice Address - Country:US
Practice Address - Phone:312-351-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-004015101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional