Provider Demographics
NPI:1962908236
Name:RAUCHFUSS, KIMBERLY ANN (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:RAUCHFUSS
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-7477
Mailing Address - Country:US
Mailing Address - Phone:847-395-9423
Mailing Address - Fax:
Practice Address - Street 1:1600 EAGLE WAY
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-7477
Practice Address - Country:US
Practice Address - Phone:847-395-9423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool