Healthcare Provider Details

I. General information

NPI: 1659970903
Provider Name (Legal Business Name): MR. DANIEL JOSEPH KRAFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 07/16/2023
Certification Date: 07/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 WAUKEGAN RD STE 103
GLENVIEW IL
60025-3070
US

IV. Provider business mailing address

950 LEE ST STE 210
DES PLAINES IL
60016-6574
US

V. Phone/Fax

Practice location:
  • Phone: 847-486-4140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-64970
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-139952
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: