Basic Information
| Provider Information | |||||||||
| NPI: | 1285047415 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRAUTSAK | ||||||||
| FirstName: | CHERYL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 ELDER LN | ||||||||
| Address2: | |||||||||
| City: | FOX RIVER GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600211532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478283378 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4100 VETERANS PKWY | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153441230 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2014 | ||||||||
| LastUpdateDate: | 09/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.