Provider Demographics
NPI:1649247214
Name:FLOWERS-VALACAK, TRACI LYN (ATC)
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:LYN
Last Name:FLOWERS-VALACAK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 HERMITAGE LN
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3032
Mailing Address - Country:US
Mailing Address - Phone:847-839-9970
Mailing Address - Fax:
Practice Address - Street 1:280 N RANDALL RD
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5903
Practice Address - Country:US
Practice Address - Phone:847-854-8219
Practice Address - Fax:847-854-8278
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer