Provider Demographics
NPI:1982970141
Name:FEHR, CARRIE LYNNE (MT-BC)
Entity type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:LYNNE
Last Name:FEHR
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 HINMAN AVE
Mailing Address - Street 2:APT. 216
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2371
Mailing Address - Country:US
Mailing Address - Phone:773-609-5655
Mailing Address - Fax:
Practice Address - Street 1:2008 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1017
Practice Address - Country:US
Practice Address - Phone:874-425-9708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-31
Last Update Date:2012-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL09864225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist