Provider Demographics
NPI:1902960537
Name:GOURIOTIS, TRACI RITA (MS SLPL CCC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:RITA
Last Name:GOURIOTIS
Suffix:
Gender:F
Credentials:MS SLPL CCC
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:RITA
Other - Last Name:JERRICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1049 EAST WILSON STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510
Mailing Address - Country:US
Mailing Address - Phone:630-761-0900
Mailing Address - Fax:630-761-0909
Practice Address - Street 1:1049 EAST WILSON STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510
Practice Address - Country:US
Practice Address - Phone:630-761-0900
Practice Address - Fax:630-761-0909
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist