Healthcare Provider Details

I. General information

NPI: 1407226806
Provider Name (Legal Business Name): TRACY NORRIS SLAGER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E BELTLINE AVE NE FL 3
GRAND RAPIDS MI
49525-8614
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-447-5820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015085
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: