Healthcare Provider Details

I. General information

NPI: 1629766787
Provider Name (Legal Business Name): TRACY DOERING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 29TH ST UNIT 1292
BOULDER CO
80301-1010
US

IV. Provider business mailing address

1601 29TH ST UNIT 1292
BOULDER CO
80301-1010
US

V. Phone/Fax

Practice location:
  • Phone: 303-335-0361
  • Fax:
Mailing address:
  • Phone: 303-335-0361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09930757
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW23193
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: