Basic Information
| Provider Information | |||||||||
| NPI: | 1447743208 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRAZIER | ||||||||
| FirstName: | ABIGAIL | ||||||||
| MiddleName: | DAPHENE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RBT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FRAZIER | ||||||||
| OtherFirstName: | ABIGAIL | ||||||||
| OtherMiddleName: | DAPHENE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | BCBA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7360 N LINCOLN AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | LINCOLNWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607121705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8558552712 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7360 N LINCOLN AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | LINCOLNWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607121705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8558552712 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2018 | ||||||||
| LastUpdateDate: | 04/08/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-19-34648 | TX | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 106S00000X | RBT-16-12372 | TX | Y |
No ID Information.