Healthcare Provider Details

I. General information

NPI: 1831009315
Provider Name (Legal Business Name): CAMERON D FRAZIER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18515 COUNTRY LN
LANSING IL
60438-2582
US

IV. Provider business mailing address

18515 COUNTRY LN
LANSING IL
60438-2582
US

V. Phone/Fax

Practice location:
  • Phone: 312-772-9993
  • Fax:
Mailing address:
  • Phone: 312-772-9993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.030416
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: