Provider Demographics
NPI:1740910314
Name:FRAZIER, COURTNEY N (MS)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:N
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 LOVELL ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-3641
Mailing Address - Country:US
Mailing Address - Phone:224-325-0777
Mailing Address - Fax:
Practice Address - Street 1:8201 CASS AVE
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-5314
Practice Address - Country:US
Practice Address - Phone:630-590-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician