Provider Demographics
NPI:1063930089
Name:MAGERS, TRACY (LSW CADC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MAGERS
Suffix:
Gender:F
Credentials:LSW CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 N CLARENDON AVE
Mailing Address - Street 2:915
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613
Mailing Address - Country:US
Mailing Address - Phone:312-324-0452
Mailing Address - Fax:
Practice Address - Street 1:4343 N CLARENDON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2698
Practice Address - Country:US
Practice Address - Phone:312-324-0452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.014640104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker