Healthcare Provider Details

I. General information

NPI: 1528431137
Provider Name (Legal Business Name): TRACI DONIELLE HALL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 S BELL AVE APT 100-2
CHICAGO IL
60643-3909
US

IV. Provider business mailing address

11100 S BELL AVE APT 100-2
CHICAGO IL
60643-3909
US

V. Phone/Fax

Practice location:
  • Phone: 773-255-5636
  • Fax:
Mailing address:
  • Phone: 773-255-5636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37455
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34011317A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149022581
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: