Provider Demographics
NPI:1447743208
Name:FRAZIER, ABIGAIL DAPHENE (RBT)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:DAPHENE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:DAPHENE
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:7360 N LINCOLN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1705
Mailing Address - Country:US
Mailing Address - Phone:855-855-2712
Mailing Address - Fax:
Practice Address - Street 1:7360 N LINCOLN AVE STE 110
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1705
Practice Address - Country:US
Practice Address - Phone:855-855-2712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-19-34648103K00000X
TXRBT-16-12372106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst