Provider Demographics
NPI:1841549532
Name:CANETE, TRACEY MAE
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:MAE
Last Name:CANETE
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 1:303 NEES ST
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61534-8053
Mailing Address - Country:US
Mailing Address - Phone:309-352-3045
Mailing Address - Fax:
Practice Address - Street 1:615 N PROMENADE ST
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:IL
Practice Address - Zip Code:62644-1243
Practice Address - Country:US
Practice Address - Phone:309-543-8578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009411235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist