Provider Demographics
NPI:1710367438
Name:BOOKLER, TRACI ALLISON
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:ALLISON
Last Name:BOOKLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TRACI
Other - Middle Name:A
Other - Last Name:GUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:291 SMETHWICK LN
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3523
Mailing Address - Country:US
Mailing Address - Phone:630-373-5723
Mailing Address - Fax:
Practice Address - Street 1:291 SMETHWICK LN
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3523
Practice Address - Country:US
Practice Address - Phone:630-373-5723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist