Tracy Nieman Llc | |
622 Davis St Evanston IL 60201-4491 | |
(773) 294-0176 | |
Not Available |
Full Name | Tracy Nieman Llc |
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Speciality | Counselor - Professional |
Location | 622 Davis St, Evanston, Illinois |
Authorized Official Name and Position | Tracy Nieman (BUSINESS OWNER OF LCC) |
Authorized Official Contact | 7735511235 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Tracy Nieman Llc 4827 N Rockwell St Apt 2e Chicago IL 60625-2840 Ph: () - | Tracy Nieman Llc 622 Davis St Evanston IL 60201-4491 Ph: (773) 294-0176 |
NPI Number | 1356975965 |
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Provider Enumeration Date | 02/24/2020 |
Last Update Date | 02/24/2020 |
Certification Date | 02/24/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356975965 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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