Provider Demographics
NPI:1922297340
Name:TRATNIK, TODD A (LCPC)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:A
Last Name:TRATNIK
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 N MAIN ST
Mailing Address - Street 2:#206
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-1688
Mailing Address - Country:US
Mailing Address - Phone:815-282-1166
Mailing Address - Fax:815-282-1169
Practice Address - Street 1:3703 N MAIN ST
Practice Address - Street 2:#206
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-1688
Practice Address - Country:US
Practice Address - Phone:815-282-1166
Practice Address - Fax:815-282-1169
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006922101YM0800X
IL178004492101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional