Provider Demographics
NPI:1982171393
Name:RAAB, LAURA (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:RAAB
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MATCHINIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4940 147TH CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-2404
Mailing Address - Country:US
Mailing Address - Phone:708-997-0723
Mailing Address - Fax:
Practice Address - Street 1:4940 147TH CT
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-2404
Practice Address - Country:US
Practice Address - Phone:708-997-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician