Provider Demographics
NPI:1194813139
Name:CHRONIAK, KAREN RAMBO (PHD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:RAMBO
Last Name:CHRONIAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:MARIE
Other - Last Name:RAMBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 S MICHIGAN AVE
Mailing Address - Street 2:STE 1457
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-6181
Mailing Address - Country:US
Mailing Address - Phone:312-588-0870
Mailing Address - Fax:312-588-0890
Practice Address - Street 1:122 SOUTH MICHIGAN AVENUE
Practice Address - Street 2:SUITE 1457
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6191
Practice Address - Country:US
Practice Address - Phone:312-786-9773
Practice Address - Fax:312-588-0890
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006060103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632367OtherBLUE CROSS BLUE SHIELD
IL212406Medicare ID - Type Unspecified