Healthcare Provider Details

I. General information

NPI: 1699290262
Provider Name (Legal Business Name): TRACEY L ZION LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8731 BANKERS ST UNIT A
FLORENCE KY
41042-4240
US

IV. Provider business mailing address

11100 KY HIGHWAY 185
BOWLING GREEN KY
42101-3302
US

V. Phone/Fax

Practice location:
  • Phone: 859-282-8840
  • Fax: 859-282-8830
Mailing address:
  • Phone: 513-532-4056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberI.1200905-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1200905-SUPV
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number254486
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: