Provider Demographics
NPI:1427228857
Name:PARKER, TRACEY LEE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:LEE
Last Name:PARKER
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 1:2923 COUNTRY MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-8511
Mailing Address - Country:US
Mailing Address - Phone:815-765-3707
Mailing Address - Fax:815-765-3707
Practice Address - Street 1:415 S MULFORD RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-3011
Practice Address - Country:US
Practice Address - Phone:815-566-5232
Practice Address - Fax:815-765-3707
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2009-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490127331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical