Provider Demographics
NPI:1013662881
Name:DIEHL, TRACY A (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:DIEHL
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 1:570 DEVONAIRE PKWY
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-8502
Mailing Address - Country:US
Mailing Address - Phone:815-761-3382
Mailing Address - Fax:
Practice Address - Street 1:570 DEVONAIRE PKWY
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-8502
Practice Address - Country:US
Practice Address - Phone:815-761-3382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-19
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health