Provider Demographics
NPI:1063904951
Name:PATTERSON, TRACI (LCPC, CADC)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N LASALLE ST
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-1226
Mailing Address - Country:US
Mailing Address - Phone:312-219-4423
Mailing Address - Fax:312-893-7006
Practice Address - Street 1:203 N LASALLE ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-1226
Practice Address - Country:US
Practice Address - Phone:303-518-6093
Practice Address - Fax:312-893-7006
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YM0800X
IL180012608101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health