Active NPI
Tracy Fisher
- Behavior Analyst
- Crystal Lake, IL
National Provider Identifier
1205667565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-25-80883
- Practice address
- 293 Elmwood Ave
Crystal Lake, IL 60014-5146 - Phone
- (630) 940-6892
- NPI assigned
- Aug 9, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | BACB641394 | IL | |
| Behavior Analyst | 103K00000X | 1-25-80883 | IL | Primary |
Addresses
Primary practice location
293 Elmwood Ave
Crystal Lake, IL 60014-5146
Mailing address
293 Elmwood Ave
Crystal Lake, IL 60014-5146
Phone (630) 940-6892
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BACB641394 | IL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755475200000",
"number": "1205667565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "293 ELMWOOD AVE",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600145146",
"telephone_number": "630-940-6892"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "293 ELMWOOD AVE",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600145146",
"telephone_number": "630-940-6892"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISHER",
"first_name": "TRACY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-09",
"last_updated": "2025-08-18",
"certification_date": "2025-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IL",
"license": "BACB641394",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "IL",
"license": "1-25-80883",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.