Provider Demographics
NPI:1336683739
Name:AGRAWAL, SIMRAN
Entity Type:Individual
Prefix:
First Name:SIMRAN
Middle Name:
Last Name:AGRAWAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W NORTH AVE
Mailing Address - Street 2:APT 707
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1248
Mailing Address - Country:US
Mailing Address - Phone:774-262-7792
Mailing Address - Fax:
Practice Address - Street 1:1260 IROQUOIS AVE STE 306
Practice Address - Street 2:APT 707
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8549
Practice Address - Country:US
Practice Address - Phone:331-229-8839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician