Provider Demographics
NPI:1306626627
Name:ARDIZZONE-DROESCH, TRACEY ANNE (LSW, PC)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:ANNE
Last Name:ARDIZZONE-DROESCH
Suffix:
Gender:F
Credentials:LSW, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 COUR D ALENE
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-2404
Mailing Address - Country:US
Mailing Address - Phone:630-327-9639
Mailing Address - Fax:
Practice Address - Street 1:15 COUR D ALENE
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-2404
Practice Address - Country:US
Practice Address - Phone:630-327-9639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1097641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical