Provider Demographics
NPI:1548905045
Name:ROBINSON, TRACEY
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:CANTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9703 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-1018
Mailing Address - Country:US
Mailing Address - Phone:309-750-1898
Mailing Address - Fax:
Practice Address - Street 1:1813 N MILL ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1289
Practice Address - Country:US
Practice Address - Phone:847-942-2512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor