Provider Demographics
NPI:1760713739
Name:COFFEY, TRACY ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:COFFEY
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:P.O. BOX 664
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-0140
Mailing Address - Country:US
Mailing Address - Phone:630-907-9104
Mailing Address - Fax:847-381-8042
Practice Address - Street 1:825 W STATE ST
Practice Address - Street 2:SUITE 107D
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2080
Practice Address - Country:US
Practice Address - Phone:630-267-6794
Practice Address - Fax:630-907-9104
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490140841041C0700X
IL149.0140841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical