Provider Demographics
NPI:1518499474
Name:FRASCA, KRISTIN (MS, DT)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:
Last Name:FRASCA
Suffix:
Gender:F
Credentials:MS, DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 N MONTICELLO AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2374
Mailing Address - Country:US
Mailing Address - Phone:419-271-8788
Mailing Address - Fax:
Practice Address - Street 1:2301 N MONTICELLO AVE
Practice Address - Street 2:APT. 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2374
Practice Address - Country:US
Practice Address - Phone:419-271-8788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist