Provider Demographics
NPI:1073033056
Name:TRACY-TRENT, MEGAN (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:TRACY-TRENT
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:TRACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:400 S FRENCH DR
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:IL
Mailing Address - Zip Code:61525-9798
Mailing Address - Country:US
Mailing Address - Phone:815-677-4935
Mailing Address - Fax:
Practice Address - Street 1:400 S FRENCH DR
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:IL
Practice Address - Zip Code:61525-9798
Practice Address - Country:US
Practice Address - Phone:815-677-4935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041S0200X
IL1490220091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool