Provider Demographics
NPI:1215608591
Name:STRAKER, KASSIE DANIELLE (LCPC, ATR-BC, CADC)
Entity type:Individual
Prefix:
First Name:KASSIE
Middle Name:DANIELLE
Last Name:STRAKER
Suffix:
Gender:F
Credentials:LCPC, ATR-BC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4745 N HERMITAGE AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4438
Mailing Address - Country:US
Mailing Address - Phone:515-419-5390
Mailing Address - Fax:
Practice Address - Street 1:980 N MICHIGAN AVE STE 1400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-7500
Practice Address - Country:US
Practice Address - Phone:773-217-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010996101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional