1952317919 NPI number — DR. TRACY A LEWIS-TODD PSY.D.

Table of content: DR. TRACY A LEWIS-TODD PSY.D. (NPI 1952317919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952317919 NPI number — DR. TRACY A LEWIS-TODD PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS-TODD
Provider First Name:
TRACY
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952317919
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1228 EMERSON ST UNIT 503
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60201-3819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-769-7300
Provider Business Mailing Address Fax Number:
877-885-1438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1871 HICKS RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ROLLING MEADOWS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60008-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-469-7300
Provider Business Practice Location Address Fax Number:
877-885-1438
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  071003414 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 21622467 . This is a "BLUECROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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