Provider Demographics
NPI:1043023385
Name:KIFERBAUM, RACHEL (DT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:KIFERBAUM
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 N HERMITAGE AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1472
Mailing Address - Country:US
Mailing Address - Phone:847-651-0709
Mailing Address - Fax:
Practice Address - Street 1:1611 N HERMITAGE AVE APT 301
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1472
Practice Address - Country:US
Practice Address - Phone:847-651-0709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist