Healthcare Provider Details

I. General information

NPI: 1447196662
Provider Name (Legal Business Name): TRACY DENNIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9137 S JUSTINE ST
CHICAGO IL
60620-5036
US

IV. Provider business mailing address

9137 S JUSTINE ST
CHICAGO IL
60620-5036
US

V. Phone/Fax

Practice location:
  • Phone: 312-371-0335
  • Fax:
Mailing address:
  • Phone: 312-371-0335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number17854909
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: