MEDICARE: TRACEE JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	178022816	IL

General Provider Information

NPI Number	:	1720926165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEE JOHNSON

Provider Business Mailing Address
First Line	:	2212 WATERLEAF CT UNIT 103
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-4986
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2212 WATERLEAF CT UNIT 103
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-4986
Country	:	US
Telephone Number	:	630-696-8444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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Directions to “ TRACEE JOHNSON ” Practice Location

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