Provider Demographics
NPI:1639336720
Name:SANDERS, TRACEY Y (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:Y
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:Y
Other - Last Name:MADISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1403
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:4205 WESTBROOK DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4124
Practice Address - Country:US
Practice Address - Phone:815-942-6323
Practice Address - Fax:630-527-1244
Is Sole Proprietor?:No
Enumeration Date:2008-05-17
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005249101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional