Provider Demographics
NPI:1730708454
Name:RANKINS, TRACIE LYN
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:LYN
Last Name:RANKINS
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 1:1324 E IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-3202
Mailing Address - Country:US
Mailing Address - Phone:630-837-9000
Mailing Address - Fax:
Practice Address - Street 1:1324 E IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-3202
Practice Address - Country:US
Practice Address - Phone:630-837-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178011540101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional