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General NPI Number Information
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NPI Number | 1811488810
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Entity Type | Organization
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Legal Business Name | JULIE AND MICHAEL TRACY FAMILY FOUNDATION
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 1212 W FLOURNOY ST
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City | CHICAGO
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State | IL
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Zip | 60607-3327
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Country | US
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Telephone | 773-377-5691
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 W FLOURNOY ST
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City | CHICAGO
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State | IL
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Zip | 60607-3327
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Country | US
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Telephone | 773-377-5691
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | HEATHER M TARCZAN
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Credential |
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Telephone | 773-377-5691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146001362
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License Number State | IL
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