Healthcare Provider Details

I. General information

NPI: 1134462229
Provider Name (Legal Business Name): TRACY DAWN MONROE LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 STATE ST SE
GRAND RAPIDS MI
49503-4312
US

IV. Provider business mailing address

311 STATE ST
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-249-0159
  • Fax: 616-249-8688
Mailing address:
  • Phone: 616-249-0159
  • Fax: 616-249-8688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801087796
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: