Provider Demographics
NPI:1083750038
Name:GUNNELLS-KERZICH, TRACI RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:RENEE
Last Name:GUNNELLS-KERZICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 W JEFFERSON ST
Mailing Address - Street 2:215
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5261
Mailing Address - Country:US
Mailing Address - Phone:815-773-0772
Mailing Address - Fax:815-773-0771
Practice Address - Street 1:2803 BUTTERFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1165
Practice Address - Country:US
Practice Address - Phone:630-424-9204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490115891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical