Provider Demographics
NPI:1992920102
Name:CRONKHITE, CAROL ANN (PT)
Entity type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:ANN
Last Name:CRONKHITE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 HOBBY AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1149
Mailing Address - Country:US
Mailing Address - Phone:815-469-0890
Mailing Address - Fax:
Practice Address - Street 1:18210 LA GRANGE RD
Practice Address - Street 2:STE 1
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-7722
Practice Address - Country:US
Practice Address - Phone:708-478-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist