Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 10421502 | IL |
NPI | 1255546867 |
---|---|
Provider Name | Ms. Tracy L Torgerson |
First Address | Streamwood, IL 60107-1130 |
Second Address | Streamwood, IL 60107-1130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 26/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10421502 | INTL LC CERT. NUMBER (01) | |
55380867 | STATE TAX ID NUMBER (01) | IL |