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General NPI Number Information
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NPI Number | 1922297340
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Entity Type | Individual
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Provider Name | TODD A. TRATNIK LCPC
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Gender | Male
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 3703 N MAIN ST #206
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City | ROCKFORD
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State | IL
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Zip | 61103-1688
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Country | US
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Telephone | 815-282-1166
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Fax | 815-282-1169
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Provider Business Mailing Address
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Address Line | 3703 N MAIN ST #206
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City | ROCKFORD
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State | IL
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Zip | 61103-1688
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Country | US
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Telephone | 815-282-1166
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Fax | 815-282-1169
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180006922
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178004492
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License Number State | IL
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