Provider Demographics
NPI:1417212150
Name:MCDONALD, TRACY J
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:J
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 DOTY RD STE A
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-7530
Mailing Address - Country:US
Mailing Address - Phone:815-334-5018
Mailing Address - Fax:815-206-2822
Practice Address - Street 1:3707 DOTY RD STE A
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-7530
Practice Address - Country:US
Practice Address - Phone:815-334-5018
Practice Address - Fax:815-206-2822
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041370037163WP0807X
OR201500684NP-PP363LP0808X
IL209009729363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health