Healthcare Provider Details

I. General information

NPI: 1851253553
Provider Name (Legal Business Name): PRISCILLA JANE CASTLE FRALEIGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 SKOKIE BLVD
NORTHBROOK IL
60062-4118
US

IV. Provider business mailing address

244 CUMNOR RD
KENILWORTH IL
60043-1115
US

V. Phone/Fax

Practice location:
  • Phone: 847-441-5600
  • Fax:
Mailing address:
  • Phone: 847-251-4710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number208001401
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: