Provider Demographics
NPI:1659313229
Name:LOLAND KNOTEK, TRACY ANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ANNE
Last Name:LOLAND KNOTEK
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 1:526 MICHIGAN AVE
Mailing Address - Street 2:APT 3S
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3032
Mailing Address - Country:US
Mailing Address - Phone:773-396-0477
Mailing Address - Fax:
Practice Address - Street 1:526 MICHIGAN AVE
Practice Address - Street 2:APT 3S
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3032
Practice Address - Country:US
Practice Address - Phone:773-396-0477
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical