Provider Demographics
NPI:1033899737
Name:TEICHMAN, TRACY LEE
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:TEICHMAN
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 1:1804 N NAPER BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8830
Mailing Address - Country:US
Mailing Address - Phone:630-332-2358
Mailing Address - Fax:
Practice Address - Street 1:1804 N NAPER BLVD STE 250
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8830
Practice Address - Country:US
Practice Address - Phone:630-332-2358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health