Healthcare Provider Details

I. General information

NPI: 1285804757
Provider Name (Legal Business Name): KATHERINE RUTH PIERSON FRUHAUFF PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE FRUHAUFF PSY.D.

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 CRAWFORD AVE STE 104
EVANSTON IL
60201-4954
US

IV. Provider business mailing address

2530 CRAWFORD AVE STE 104
EVANSTON IL
60201-4954
US

V. Phone/Fax

Practice location:
  • Phone: 224-408-0019
  • Fax: 855-217-0165
Mailing address:
  • Phone: 224-408-0019
  • Fax: 855-217-0165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007441
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: