Provider Demographics
NPI:1700568276
Name:VAZQUEZ, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E COURT OF SHOREWOOD
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-2501
Mailing Address - Country:US
Mailing Address - Phone:224-381-6159
Mailing Address - Fax:
Practice Address - Street 1:150 E COOK AVE STE 100
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2060
Practice Address - Country:US
Practice Address - Phone:847-816-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical