MEDICARE: CRISTIE FRY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149024003	IL

General Provider Information

NPI Number	:	1619403953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTIE FRY LCSW

Provider Business Mailing Address
First Line	:	11000 US RT. 34
Second Line	:	SUITE 3
City	:	PLANO
State	:	IL
Zip	:	60545
Country	:	US
Telephone Number	:	847-457-6730
Fax Number	:	847-485-5617

Provider Business Practice Location Address
First Line	:	11000 US RT. 34
Second Line	:	SUITE 3
City	:	PLANO
State	:	IL
Zip	:	60545
Country	:	US
Telephone Number	:	847-457-6730
Fax Number	:	847-485-5617

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2017
Last Update Date	:	12/09/2025

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Directions to “ CRISTIE FRY LCSW” Practice Location

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