Healthcare Provider Details

I. General information

NPI: 1023307766
Provider Name (Legal Business Name): TRACY DORELE THIEM PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 09/02/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEMORY CHECK PSYCHOLOGICAL SERVICES PC 1902 WRIGHT PLACE, 2 FL
CARLSBAD CA
92008
US

IV. Provider business mailing address

P.O BOX 713
SUN PRAIRIE WI
53590
US

V. Phone/Fax

Practice location:
  • Phone: 888-515-3834
  • Fax:
Mailing address:
  • Phone: 707-637-3022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number24037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: