Healthcare Provider Details

I. General information

NPI: 1942480546
Provider Name (Legal Business Name): TEAM FRAHER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 N STAVE ST
CHICAGO IL
60647-4054
US

IV. Provider business mailing address

2124 N STAVE ST
CHICAGO IL
60647-4054
US

V. Phone/Fax

Practice location:
  • Phone: 773-782-3189
  • Fax: 773-782-3189
Mailing address:
  • Phone: 773-782-3189
  • Fax: 773-782-3189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. KIMBERLY FRAHER
Title or Position: SPEECH PATHOLOGIST
Credential: M.ED.
Phone: 773-782-3189