Provider Demographics
NPI:1447754221
Name:RAUH, KRISTIN J
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:J
Last Name:RAUH
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 1:4110 LITT DR
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162-1120
Mailing Address - Country:US
Mailing Address - Phone:708-547-3560
Mailing Address - Fax:
Practice Address - Street 1:4110 LITT DR
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-1120
Practice Address - Country:US
Practice Address - Phone:708-547-3560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty