Provider Demographics
NPI:1255546867
Name:TORGERSON, TRACY L (IBCLC, RLC)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:L
Last Name:TORGERSON
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 W GREEN MEADOWS BLVD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-1130
Mailing Address - Country:US
Mailing Address - Phone:224-200-7031
Mailing Address - Fax:312-626-2434
Practice Address - Street 1:41 W GREEN MEADOWS BLVD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-1130
Practice Address - Country:US
Practice Address - Phone:224-200-7031
Practice Address - Fax:312-626-2434
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL10421502174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
10421502OtherINTL LC CERT. NUMBER
IL55380867OtherSTATE TAX ID NUMBER
205405757OtherEIN NUMBER