Provider Demographics
NPI:1932252764
Name:BOHL, TRACEY A
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:A
Last Name:BOHL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TRACEY
Other - Middle Name:A
Other - Last Name:DOUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 W NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1422
Mailing Address - Country:US
Mailing Address - Phone:708-670-6720
Mailing Address - Fax:833-371-2578
Practice Address - Street 1:200 W NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1422
Practice Address - Country:US
Practice Address - Phone:708-670-6720
Practice Address - Fax:833-371-2578
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007674235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist