Provider Demographics
NPI:1275970410
Name:STEGE, TRACEY AMANDA (BA)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:AMANDA
Last Name:STEGE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 W. 216 PLACE
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443
Mailing Address - Country:US
Mailing Address - Phone:708-508-6267
Mailing Address - Fax:708-429-5868
Practice Address - Street 1:7050 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1649
Practice Address - Country:US
Practice Address - Phone:708-614-1782
Practice Address - Fax:708-429-5868
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist