Provider Demographics
NPI:1487925863
Name:TOLEDO, TRACEY N (MS, SLP)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:N
Last Name:TOLEDO
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:N
Other - Last Name:TOLEDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17928 FOUNTAIN CIR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8100
Mailing Address - Country:US
Mailing Address - Phone:708-557-1201
Mailing Address - Fax:
Practice Address - Street 1:16424 HAVEN AVE
Practice Address - Street 2:
Practice Address - City:ORLAND HILLS
Practice Address - State:IL
Practice Address - Zip Code:60487-5626
Practice Address - Country:US
Practice Address - Phone:708-557-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242002145235Z00000X
IL146.011949235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1487925863Medicaid