Provider Demographics
NPI:1356965768
Name:FRASER, HEATHER M (LCSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:FRASER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 N WASHTENAW AVE APT 1S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-0585
Mailing Address - Country:US
Mailing Address - Phone:773-220-9899
Mailing Address - Fax:
Practice Address - Street 1:2430 N WASHTENAW AVE APT 1S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-0585
Practice Address - Country:US
Practice Address - Phone:773-220-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0128031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical