MEDICARE: TRACY CAPRARO

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	103TS0200X	School Psychologist	523411	IL

General Provider Information

NPI Number	:	1609347723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY CAPRARO

Provider Business Mailing Address
First Line	:	236 INDIANAPOLIS AVE
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-3100
Country	:	US
Telephone Number	:	708-296-3956
Fax Number	:

Provider Business Practice Location Address
First Line	:	236 INDIANAPOLIS AVE
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-3100
Country	:	US
Telephone Number	:	708-296-3956
Fax Number	:

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

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	12/16/2018

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Directions to “ TRACY CAPRARO ” Practice Location

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