Provider Demographics
NPI:1376770545
Name:KRAHL, ERICA ROBIN (MA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:ROBIN
Last Name:KRAHL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 S BROADWAY ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COAL CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60416-1699
Mailing Address - Country:US
Mailing Address - Phone:815-634-3994
Mailing Address - Fax:815-634-2738
Practice Address - Street 1:275 S BROADWAY ST
Practice Address - Street 2:SUITE 2
Practice Address - City:COAL CITY
Practice Address - State:IL
Practice Address - Zip Code:60416-1699
Practice Address - Country:US
Practice Address - Phone:815-634-3994
Practice Address - Fax:815-634-2738
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003246101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional