| Fraser Vaselakos & Associates, Pc | |
|
12627 W 143rd St Homer Glen IL 60491-8381 | |
| (708) 645-0798 | |
| (708) 645-0841 |
| Full Name | Fraser Vaselakos & Associates, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 12627 W 143rd St, Homer Glen, Illinois |
| Authorized Official Name and Position | M. Denise Fraser Vaselakos (OWNER) |
| Authorized Official Contact | 7086450798 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fraser Vaselakos & Associates, Pc 12627 W 143rd St Homer Glen IL 60491-8381 Ph: (708) 645-0798 | Fraser Vaselakos & Associates, Pc 12627 W 143rd St Homer Glen IL 60491-8381 Ph: (708) 645-0798 |
| NPI Number | 1821168162 |
|---|---|
| Provider Enumeration Date | 11/08/2006 |
| Last Update Date | 06/19/2008 |
| Medicare PECOS PAC ID | 2062583594 |
|---|---|
| Medicare Enrollment ID | O20080611000332 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821168162 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071004958 (Illinois) | Primary |
| Provider Name | M Denise Fraser Vaselakos |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982872594 PECOS PAC ID: 8527139054 Enrollment ID: I20080611000324 |
| Provider Name | Michelle R Krepps |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477713980 PECOS PAC ID: 9234201997 Enrollment ID: I20080712000107 |
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