Healthcare Provider Details

I. General information

NPI: 1336096528
Provider Name (Legal Business Name): SERENA FRAZIER-THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 MOON LAKE BLVD STE 140
HOFFMAN ESTATES IL
60169-1070
US

IV. Provider business mailing address

8532 SKOKIE BLVD APT B1
SKOKIE IL
60077-2373
US

V. Phone/Fax

Practice location:
  • Phone: 708-927-4127
  • Fax:
Mailing address:
  • Phone: 708-927-4127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: