Provider Demographics
NPI:1942480546
Name:TEAM FRAHER INC
Entity Type:Organization
Organization Name:TEAM FRAHER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAHER
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:773-782-3189
Mailing Address - Street 1:2124 N STAVE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4054
Mailing Address - Country:US
Mailing Address - Phone:773-782-3189
Mailing Address - Fax:773-782-3189
Practice Address - Street 1:2124 N STAVE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4054
Practice Address - Country:US
Practice Address - Phone:773-782-3189
Practice Address - Fax:773-782-3189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency