Provider Demographics
NPI:1992293872
Name:THAKRAL, SHALU (LCSW)
Entity type:Individual
Prefix:
First Name:SHALU
Middle Name:
Last Name:THAKRAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 WINNETKA RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1349
Mailing Address - Country:US
Mailing Address - Phone:773-710-5237
Mailing Address - Fax:
Practice Address - Street 1:825 GREEN BAY RD STE 200
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2500
Practice Address - Country:US
Practice Address - Phone:847-251-6630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490100471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical