Provider Demographics
NPI:1053150185
Name:BRAME, KEARSHA
Entity type:Individual
Prefix:
First Name:KEARSHA
Middle Name:
Last Name:BRAME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9760 S ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-3119
Mailing Address - Country:US
Mailing Address - Phone:309-838-0334
Mailing Address - Fax:
Practice Address - Street 1:9224 S WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-8012
Practice Address - Country:US
Practice Address - Phone:309-838-0334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician